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INTRODUCTION

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Recent decades have seen advances in the management and rehabilitation care of individuals with upper limb amputation. Prostheses for the person with upper limb amputation have changed greatly, with improvements in components, socket fabrication, fitting techniques, suspension system and sources of control, electronics, and power. Higher levels of limb amputation can now be fitted with functional prostheses, which allow more patients to achieve independent lifestyles. This is of particular importance for the multilimb amputee.

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For the upper limb amputee, myoelectrically and proportional controlled terminal devices and elbow joints are now used routinely in some rehabilitation programs. These devices have greatly improved the functional outcomes of patients with upper limb amputation. Progress in the areas of prosthetic fitting techniques and devices (eg, use of osseo-implantation for suspension of the prosthesis) and development of control systems is ongoing, and further developments are expected to take place as technology and the human–machine interface improves.

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EPIDEMIOLOGY

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The exact number of people around the world who have a major amputation is difficult to ascertain as many countries do not keep records of the number of people with limb amputation. Based on information available from the National Center for Health Statistics, there are approximately 100,000 new amputations every year in the United States. Extrapolating from these and other sources of health statistics worldwide, the major causes of amputation in order of incidence are trauma (including war-related injuries), diseases (eg, malignancies and arterial insufficiency), and congenital limb deficiencies. The causes of amputation vary from country to country. Because medical comorbidities leading to limb loss most often imperil the lower extremity, more lower limb than upper limb amputations occur, at a ratio of almost 5 to 1. Congenital limb deficiencies account for a small proportion of the total number of reported limb amputations, with a reported incidence of 4.1 per 10,000 live births.

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Trauma-related amputations usually occur as a result of motor vehicle, military conflict, industrial, or farming accidents and may account for up to 30% of new major limb amputations. Traumatic amputations occur in a much younger, active, and economically productive population. Sixty percent of arm amputees are between the ages of 21 and 65 years, and 10% are younger than 21 years. Because of the higher risk of work-related accidents in men, there is a higher number of trauma-related amputations for this gender and, overall, a higher incidence of upper limb amputation.

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Amputation of the distal segment of the upper limb is more common than proximal amputation and can occur at any age. Men between the second and fourth decades are most frequently affected, with involvement of the right more often than the left limb (related to dominance). The transradial level accounts for 65% and the transhumeral level for 25% of upper limb amputations. Shoulder, elbow, and wrist disarticulation levels together account for the remaining 10%.

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Østlie  K, Skjeldal ...

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