Surgeon weighs in on rehabilitation for patients injured during Boston Marathon bombings

After the Boston Marathon bombings that killed 3 people and injured 264 people, orthopedic surgeons treated wounds normally seen in a wartime setting. The injuries involved all layers of the extremity and varied greatly: surgeons were treating patients with burns, fractures, retained fragmentation and soft tissue loss. These patients will need multiple surgeries to stabilize, repair bone and repair soft tissue before they can start rehabilitation.

“The injuries sustained as a result of the terrorist pressure-cooker bombs is very similar to the [improvised explosive device] IED injuries sustained by our soldiers in Iraq and Afghanistan,” Michael S. Pinzur, MD, an Orthopedics Today Editorial Board member, told Orthopedics Today.

“My observation from caring for traumatic amputees for over 30 years is that most amputees share the same positive vision while they are in the hospital.”

Michael S. Pinzur

These patients are most likely in their preliminary stages of grief, Pinzur said, and will follow the five stages of grief popularized in the Kübler-Ross model. He cited the Military Extremity Trauma Amputation/Limb Salvage (METALS) study published by Doukas and colleagues as an example of recent amputees developing symptoms of depression or post-traumatic stress disorder (PTSD). In the study, 38.3% of recent military amputees tested positive for depressive symptoms and 17.9% developed post-traumatic stress disorder.

“The Boston amputees will likely develop the same PTSD seen in the METALS subjects and will be faced with the same challenges,” Pinzur said.

Patients will also need state-of-the-art prostheses, which Pinzur said the orthotics and prosthetics industry has already begun to provide. More than anything, patients will need the support of their family and friends to recover from their injuries.

“They will need appropriate family support and counseling to have any chance to resurrect their lives,” Pinzur said. “Much like the amputees from the [Lower Extremity Assessment Project] LEAP and METALS studies, the people that fare best are those with the best family support. When the news interest wanes, the Boston survivors that succeed will be the ones that get more than state-of-the-art prostheses.”

Reference:

Doukas WC. J Bone Joint Surg Am. 2013;doi:10.2106/JBJS.K.00734.

Disclosure: Pinzur has no relevant financial disclosures.