Traumatic Amputation

Traumatic amputation - the accidental severing of a part or all of a body part, is a life-threatening and life-altering event. Men are at a considerably higher risk for trauma-related amputations. In both men and women, the risk of traumatic amputation increases with age, culminating in the highest risk for those 85 years or older. More than 65% of traumatic amputations are of the upper limbs. Injuries that lead to traumatic amputation include car accidents, especially motorcycle or bicycle accidents, construction injuries, and other work-related injuries.

Statistics give you the numbers, but they can’t tell you the stories of the people involved: their daily struggles to survive and overcome their injuries, the pain they experience, the stress on them and their families, and the strain on their finances.

When you suffer a traumatic amputation because of someone else’s negligence, it is important to learn what your rights are and what remedies may be available to you. Contact the experienced personal injury attorneys at Ross Law Group, who know how to evaluate the legal liabilities of all of the parties involved and help you achieve the maximum recovery available from each liable party.

If you are the parent, spouse or family member of a person who has suffered a serious personal injury and can’t act for him or herself, you need to act quickly on their behalf. Valuable evidence can be lost or destroyed, or witnesses may forget important facts, if an investigation by your own counsel is delayed. Contact us for a consultation as soon as possible after a serious injury occurs.

Proving liability in injury cases is often easier said than done. Investigating the circumstances under which the injury occurred and proving who was at fault is the most critical aspect of your personal injury case. When there is a fight over liability, you need an experienced lawyer on your side. Evaluation of police reports, witness statements, examination of the scene, the vehicles or products involved, and accident reconstruction are tools we can use to help prove your case.

Ross Law Group’s personal injury attorneys are experienced in traumatic injury cases. Because of their devastating effect on a person’s overall health and lifestyle, amputation injuries pose particular challenges in proving future damages. The extent of the physical damage can help indicate the economic damages the injured person will incur.

Diagnosis of traumatic amputation is easy to make when a limb or appendage is completely severed; however, when there is a partial amputation, it must be determined how much of the affected appendage can be saved. This is crucial since saving a limb or appendage can mean the difference in how much function the victim will have in the future. A traumatic injury can destroy blood vessels and cause tissue death. In some cases, if an amputation is not done, an infection can spread throughout the body and become fatal. Amputation may be complete or partial, where some soft tissue remains at the site.

In traumatic amputation, the level of amputation is determined by the level of injury. Surgeons know that preservation of limb length and joint function is of utmost importance in order for the victim to fit and use prosthesis. The energy required to use a limb increases as the limb becomes shorter. If a limb is to be removed surgically, diagnosis focuses on determining the correct level of amputation, where healing can happen with the goal of preserving as much of the limb as possible.

Terminology used by medical professionals when discussing amputation can be confusing. Amputation can involve virtually any part of the body:

• Upper extremity-arms, hands, and fingers
  • Fingers (phalanges)
  • Hand (metacarpals)
  • Wrist (carpals)
  • Forearm (radius and ulna)
  • Upper arm (humerus)
  • Shoulder blade (scapula)
  • Collarbone (clavicle)

• Lower extremities-legs, feet, and toes
  • Pelvis (pubis, ilium, and ischium)
  • Upper leg (femur)
  • Knee (patella)
  • Lower leg (tibia and fibula)
  • Foot (tarsals, metatarsals)
  • Toes (phalanges)

• Other-ears, nose, eyelids, genitalia

Partial amputation- some structure, such as a muscle, ligament, or tendon is still intact between the body and the amputated part.
Complete amputation- there are no anatomical structures attaching the amputated part to the body.
Proximal amputation- involves a body part that is closely adhered to the body’s core (i.e. an arm at the shoulder joint)
Distal amputation- involves an amputated part that is away from the body’s core (i.e. a finger or toe).
BKA- below-the-knee amputation
AKA- above-the-knee amputation

Ross Law Group’s experienced traumatic injury lawyers know that engaging medical experts who can fully explain your injuries and their effect to a jury is a vital component of proving your injury case and your damages.

Damages are the costs for treatment of injuries, lost wages and other economic losses, and the monetary value of intangible harm such as pain and suffering. Under some circumstances, an injured person may be able to recover punitive, or exemplary damages, which are intended to punish malicious or reckless behavior and to deter such conduct in the future.

Economic Damages are those that can be measured in dollars, such as:

• Medical expenses in the past
• Medical Expenses that are probable in the future
• Related expenses such as caregiving, special equipment, and special housing
• Lost wages in the past
• Lost wages and/or Loss of Earning Capacity that are probable in the future
• Attorney Fees (under some circumstances)
• Property Damage

Non-Economic Damages are those values that are not so readily assessed in dollars, such as:

• Disfigurement in the past and in the future
• Physical Pain and Suffering in the past and in the future
• Mental anguish in the past and in the future
• Punitive or exemplary damages

For every personal injury client, Ross Law Group provides a review of your earnings history for the past three years, with an emphasis on making sure that all wages due to you under the FLSA were paid. This provides essential information for proving your lost wages, and if we discover that you have been underpaid, we can assist you with a wage claim.

Many people are not aware of all of the avenues of recovery that may be available to them after an accident. Ross Law Group’s experienced traumatic injury attorneys will fully investigate the accident to determine every party that may have liability, the insurance and assets of each liable party, and the insurance benefits you may be entitled to receive from your own insurance carrier. There may also be funds you can apply for through Victim Compensation programs. There may be avenues of recovery that you are unaware of or haven’t considered. Our goal is to make you aware of every type of compensation to which you may be entitled.

Another factor that is important in managing your legal case arising from an injury is the insurance that is involved. If your injury is work-related, it is important for you to know that workers' compensation insurance is purchased by the employer to provide medical and income benefits to employees who are injured while they are doing their jobs. Workers' compensation, however, is a tradeoff. Workers' compensation provides medical and lost wage benefits to workers who are injured, but it also generally prohibits them from suing their employers, even if the employer's negligence (the failure to exercise the proper standard of care) contributed to the injuries.

If your health insurance, or workers compensation insurance provided by your employer, has paid for medical treatment, the carrier usually has the right to demand reimbursement from your monetary recovery from liable third parties. If you have underinsured motorist coverage for protection in the event that the liable party’s insurance coverage is insufficient to compensate you for your damages, you may have to obtain the permission of your insurance carrier to settle with the liable party or lose your right to recover from your own insurance.

Medical providers may file liens for the costs incurred for medical care arising for treatment of the injury. An experienced personal injury attorney will help negotiate with the medical providers to try to reduce their charges and enable you to get the maximum benefit from your recovery.

Traumatic Amputation, Recovery and Rehabilitation

Any medical evaluation of traumatic amputation starts with careful monitoring of the victim’s vital signs for signs of shock. Profuse bleeding can happen and may lead to hypovolemic shock caused by a sudden loss of blood volume if not treated promptly. Traumatic amputation of more than a finger or a toe requires assessment of airway, breathing, and circulation, as any one of these may be compromised. Blood should be drawn for measures of hemoglobin and hematocrit. The victim will be typed and cross-matched in case a blood transfusion is needed. X-rays of the affected limb or area will be done to determine the extent of bone injury. Physicians should look for other injuries that may have occurred as a result of the trauma, such as chest or abdominal injuries that may not be apparent at first.

Before surgery takes place, it is important to make sure the patient is in a stable condition. If the patient has sustained a major trauma, such as a motor vehicle accident, doctors will want to ensure that no other major injuries are present which may make surgical amputation unsafe for the patient.

The patient will be administered either a general or a regional anesthetic. When a severe trauma has occurred, surgeons usually use a general anesthetic. A regional anesthetic may be adequate for more minor amputations. The amputation procedure entails the surgeon shaping muscle and tissue in order to make a stump that will allow for comfortable use of a prosthetic device. The surgeon will also ensure that nerves are well protected, so that stump pain does not become a problem. If the amputation is a result of trauma, the surgeon will remove any crushed bone or injured tissue and will smooth any uneven areas of the bone.

Amputations may be open or closed. In an open-flap amputation, the skin is held back from the incision site, sometimes for several days. This is so the tissue can be monitored closely. This procedure is done when there is concern about infection and may be referred to as delayed closure.

In a closed amputation, the skin flaps are sewn shut immediately during the surgery. Surgeons will choose immediate closure if they are certain that there is a small risk of infection.

The length of a post-amputation hospital stay may depend on several factors:

• The type of amputation that was performed-amputations of limbs will require longer stays than an amputation of a single digit.
• How much pain you experience after the amputation, and your tolerance of the pain.
• Whether there are any complications that delay you going home, such as post-operative infection.
• Your general health
• How you manage in rehabilitation.

Typical post-amputation hospital stays can be for as long as two weeks, depending on the circumstances. Almost immediately following surgery, you will be encouraged to start moving your stump to promote circulation of the area. Physical therapy and rehabilitation will usually begin within 48 hours of surgery, as studies have shown that early rehabilitation promotes healing. Early rehabilitation also promotes acceptance of the amputation.

Rehabilitation for amputation involves a lot of education. Amputation patients must learn how to condition the stump. This is done to prepare the stump for prosthesis, and typically involves the use of stump shrinkers or elastic bandages, which are worn during the day and night. The purpose of this is to provide shape to the stump and to prevent swelling of the stump and fluid retention.

In rehabilitation for upper limb amputation, the hand or one or more of the fingers may be removed. The arm may be removed below the elbow or above it, or at the shoulder. Most patients with an amputation of an upper limb will be fitted for an artificial arm, which can include fingers, a hook or hand, a wrist unit, and an elbow unit if the patient’s amputation is above the elbow. Movement of the hook or hand is done mainly by movement of the shoulder muscles. Control of above-elbow prosthesis is generally more complicated than below-elbow prosthesis. Newer prosthetic devices can use energy produced by the patient’s own muscles to produce movement (myoelectric prosthetic devices).

Rehabilitation for an upper limb amputation involves general conditioning exercises, exercises to strengthen existing arm muscles, and relearning activities of daily living with and without a prosthesis.

In rehabilitation for lower limb amputation, the leg may be removed above or below the knee, or at the level of the hip. Alternately, a foot or one or more toes may be removed. Most patients who lose a lower limb are fitted for a prosthetic device, or an artificial leg. Rehabilitation involves exercises to stretch the hip and knee (for amputations below the knee), general exercises to strengthen existing arm and leg muscles, standing and balancing exercises (usually done with parallel bars), endurance exercises, and teaching the injured person how to avoid contractures, or muscle shortening, which can occur after prolonged bed rest or sitting in a wheelchair.

A person with a lower limb amputation may be provided with a temporary prosthesis so that learning to walk can begin. The injured person progresses from using a walker or crutches to using a cane fairly quickly, and may start to walk on his own in a matter of weeks. When the patient is ready to use the permanent prosthesis, they must learn how to put it on and take it off, how to care for the device and the stump, and how to walk in it.

Rehabilitation is generally long-term for a lower limb amputation. Patients not only have to learn how to walk; they must learn skills such as walking on uneven surfaces and up and down stairs. Walking with a prosthetic device requires much more energy, and how quickly a patient progresses through rehabilitation depends on their age and physical condition before the amputation.

The role that an experienced traumatic injury attorney plays during your treatment and recovery is to perform the investigation of the accident and receive updates on your progress from you. We document all of your medical providers’ records and billing so we can accurately assess your damages. Contact Ross Law Group to get an experienced personal injury lawyer working on your case as soon as possible.

There are many health issues that can affect amputees in the early days of recovery and down the road. The injured person needs to be aware of the potential for these complications of amputation to happen and when to notify their doctor, because many of these issues can be managed proactively. The following outlines some of the potential health issues that may affect amputation patients and some preventive measures which can be taken to avoid them.

Phantom limb pain is discomfort felt by the amputee arising from the amputated limb. It may be described as pain, a burning or itching sensation, or other unpleasant sensation. The pain is very real, and can be debilitating for some patients. There is research that has found that adequately treating pain in the postoperative period can reduce the risk of phantom pain. When phantom pain does occur, pain medications and medications for the treatment of nerve pain may be used. Other methods that may be helpful include hypnotherapy, biofeedback, and other therapies designed to alter the patient’s perception of the pain.

Contractures, or shortening of the muscles, may occur after prolonged bed rest or prolonged sitting. Contractures are one of the reasons that rehabilitation starts so soon after surgery, sometimes within 48 hours depending on the patient. Contractures are important to avoid because they make fitting aprosthesis more difficult.

Death of the Skin Flaps. Tissue necrosis, or death of the tissue that make up the skin flaps, can sometimes occur if circulation to the skin is inadequate. This may necessitate repeat surgery. To help avoid this complication, the patient can begin gently mobilizing the stump immediately after surgery to promote circulation to the area.

Wound opening can happen because of an infection, excess swelling in the stump, or too much tension on the sutures used to close the wound. Use of elastic garments (bandages), stump socks, and shrinkers may aid in protecting the stump from this complication. Antibiotics are given in the postoperative period to decrease the risk of infection.

Failure to Heal. Sometimes, stumps may not heal properly. This may happen because of poor physical health of the patient, such as diabetes, or to poor nutritional status. It may be a sign of infection in the stump. It may be due to poor circulation to the area. This complication may require further surgery.

Infection in the stump must be regarded seriously. Infection will impede wound healing. Antibiotics are often started before the amputation and continued for a period of time after the surgery. Signs of infection may include fever, drainage, and a foul wound odor.

Depression may start immediately after surgery or later, after the patient has gone home. Patients should be encouraged to talk about their feelings with a professional. Physicians should be vigilant for signs and symptoms of depression and question the patient who appears depressed. Depression is very common but should never be minimized.

Weight Gain. Many amputees gain weight after amputation due to a more sedentary lifestyle. Patients who are depressed may gain weight if eating is a comfort. Amputees may not feel comfortable exercising in public. Weight gain can be a problem if it hinders mobilization.

Prosthetic Complications. Poorly fitting prosthetics can cause redness, skin breakdown, bruising, or blister formation on the stump. It is important that an amputee regularly examine his or her stump for any signs of irritation. You should also have your prosthesis evaluated by a professional every 6 months to a year, or as recommended by your doctor.

Expenses and mental anguish caused by complications, and the need for long term post-amputation care, are important components of your damages in a personal injury case arising from a traumatic amputation. Few people anticipate that they may be victims of serious injuries and, therefore, do not make plans for what to do if it happens. In addition to the shock, pain, and physical disability that come with such an injury, there is also usually an immediate financial impact for the victim and his or her family. The assistance of an attorney experienced in handling the cases of traumatic injury victims can help prevent the financial devastation from lasting a lifetime. Contact Ross Law Group to consult with an experienced personal injury lawyer.

More Information about Types of Amputations

Upper Limb Amputations

Amputation of individual digits- the thumb is usually the most amputated digit, and loss of this digit impairs the victim’s ability to grasp objects. When the victim loses other digits, grasping ability is affected but they will retain some grasping ability.

Multiple digit amputation- when more than one digit is lost, surgeons may be able to construct muscles to aid grasping ability.

Metacarpal amputation- this type of amputation involves loss of the entire hand but the wrist is still intact; the victim will have no ability to grasp.

Wrist disarticulation- involves the loss of the hand, but at the level of the wrist joint. Technology now exists to have plastic sockets made to serve as wrists.

Forearm (transradial) amputation- this type of amputation may be classified by the length of the remaining stump. As stump length decreases, so does the victim’s pronation ability, or the ability to rotate the forearm.

Elbow disarticulation- this type of amputation involves the removal of the entire forearm at the elbow. In this type of amputation, the victim will retain the ability to hold weight.
Above-elbow (transhumeral) amputation- involves amputation anywhere above the elbow and below the shoulder. If some length is left to the humerus, a prosthesis may still be used.

Shoulder disarticulation- in this type of amputation, the shoulder blade remains. The collarbone may or may not be removed.

Forequarter amputation- includes removal of the shoulder blade and collarbone. Surgeons would ideally leave some length of bone for prosthetic use.

Lower Limb Amputations

Foot amputations- can include any portions of the foot, such as toes and mid-tarsal amputations. The big toe is commonly affected, and may affect balance and walking.

Ankle disarticulation (Syme amputation) - involves amputation of the entire ankle. In this type of amputation, the victim can mobilize without prosthesis.

Below-knee (transtibial) amputation- amputation occurs above the ankle but below the knee. Victims retain the use of the knee, but may have difficulty putting weight on the stump.

Knee-bearing amputation- amputation involves the complete removal of the lower leg. It may be difficult to create aprosthesis in this type of injury.

Above-knee (transfemoral) amputation- involves amputation at the level of the thigh. The victim will be able to sit with this type of amputation.

Hip disarticulation- involves removing the entire leg bone. Surgeons will try to preserve some length in the femur to allow the use of a prosthesis.

Injured people often ask, “How much is the settlement in a traumatic amputation personal injury case?” Even the most experienced personal injury lawyer cannot give you an easy answer to that question. Many factors affect the settlement value of a personal injury case.

The practical answer is that your settlement in a personal injury case is dependant on the amount of money available from the party of parties who are liable for your injury and from your own insurance coverage. Within the total amounts that may exist from which to demand compensation, the settlement value of your case depends on your ability to prove liability, causation, and damages. Ross Law Group’s experienced personal injury attorneys have the knowledge and skill to investigate, prepare, present, negotiate, and try your case to try to obtain the maximum recovery you are entitled to receive. When Defendants know that you have an experienced attorney who is ready to take your case to trial, they are usually more open to serious negotiation. Contact us today for a free personal injury consultation.

If you are finding it emotionally difficult to adjust to life after your amputation, please seek help. It is normal for you to find it difficult to adjust to the changes in your body and your life, and anger and depression are common reactions. Counseling, and perhaps medication for depression, can help. Tell your doctor how you are feeling. There are also support groups who can provide support, tips and guidance to you as you learn to live as an amputee. People who have gone through an amputation will understand how you are feeling. The following are organizations you can contact to direct you to support groups in your area:

Amputation Coalition of America- phone 1-888-267-5669
Amputee Resource Foundation of America- email This e-mail address is being protected from spambots. You need JavaScript enabled to view it
National Amputation Foundation- phone 1-516-887-3600

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