Before addressing "the problem," it is necessary to establish that there even is a problem. The data reported in "Traumatic amputations in children and adolescents" by A. J. Roche and K. Selvarajah provides evidence that there may be patterns in adolescent amputation injury type.
The focus of their cohort study was, "to report the demographics of severe trauma leading to amputation in an urban United Kingdom paediatric population, and to compare [their] cohort with similar groups in other units." They collected data from a center that "assesses and treats all patients within a catchment area of 1 to 1.3 million people [along with referrals from other regions] who have been referred from local hospitals with loss of digits or limbs or for advice on the management of prostheses." Roche and Selvarajah limited their study population to those, "having had an amputation as a result of trauma from any mechanism,... ≤ 18 years of age when injured."
Roche and Selvarajah were able to collect the details on 112 patients; however, only data for 93 patients, ranging from 1930 to 2011, were usable. 83 of those patients had lower -limb amputations, 48 of which were below knee.
In the geographic area they were studying, "the pedestrians injured by buses all resulted in lower-limb amputations, as did almost all the other road injuries;" bus injuries accounted for 32% of cases, and total "accidents on road accounted for 63% of all injuries."
These data suggest that, at least in the UK, automobile related injury is the dominant injury type and that lower-limb amputation is the dominant amputation type, with lower knee being the most common lower-limb amputation subtype. However, Roche and Selvarajah outline the differences between UK-based studies and US-based studies; "Paediatric amputation amputations have been studied more closely in the United States, where it seems that they are more frequent. Loder performed a demographic study similar to ours [in the United States]... and showed some contrasting results... Over half were caused by a combination of lawnmowers (29%) and farming machinery (24%), and only 16% followed road traffic accidents."
In addition to the difference in injury-cause types, the study also suggested injury resulting in amputation is less financially burdensome in the UK, although it, "has been shown to have significant financial burdens in other countries," and this might be do to the infrequency of injury resulting in amputation in the United Kingdom.
Citations to follow up on include:
Trautwein LC, Smith DG, Rivara FP. Pediatric amputation injuries: etiology, cost,
and outcome. J Trauma 1996;41:831-8.
Loder RT. Demographics of traumatic amputations in children: implications for prevention strategies. J Bone Joint Surg [Am] 2004; 86-A:923-8.
Conner KA, McKenzie LB, Xiang H, Smith GA. Pediatric traumatic amputations
and hospital resource utilization in the United States, 2003. J Trauma 2010;68:131-7.
Conner KA, Williams LE, McKenzie LB, et al. Pediatric pedestrian injuries and
associated hospital resource utilization in the United States, 2003. J Trauma
2010;68:1406-12.
Krebs DE, Fishman S. Characteristics of the child amputee population. J Pediatr
Orthop 1984;4:89-95
To read the article, follow this link: http://www.ncbi.nlm.nih.gov/pubmed/21464491 or http://www.boneandjoint.org.uk/highwire/filestream/17823/field_highwire_article_pdf/0/507.full-text.pdf
