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Amputations: statistics and trends.

Since 1955, the artificial limb fitting services in England, Wales and Northern Ireland have gathered statistics of all amputees referred for the first time. The information originally requested was basic: site of amputation, length and type of amputation stump (in inches), causes of amputation and the type of artificial limb supplied. In 1970, with the wider use of computers, much greater detail was introduced. In addition, an updating of information at 1 year after limb fitting and limb training was included, followed by a progress review at 2 years after the first attendance. If the amputee abandoned limb wearing for any reason, emigrated or died, this information was also entered into the computer. It should be remembered that the artificial limb services do not discharge their patients, therefore the young amputee becomes the responsibility of the Service for the remainder of his or her life. This responsibility covers the maintenance and replacement of the artificial limbs supplied (Fig. 1). Between 5000 and 5500 amputees are seen at the limb centres in England for the first time each year. A slight increase over the years is commensurate with the increase in the population of those in their 7th and 8th decades of life. Deaths of amputees in England each year number between 2500 and 3000, thus a small increase in the total population of amputees in England which remains between 60 000 and 65 000 thousand (1). In any study of statistics relative to amputations it is necessary to differentiate between amputation and amputee, inasmuch as one amputee may have suffered the loss of more than one limb. Likewise, it is not possible to correlate the number of amputations recorded in hospital operating theatre books because these may include minor digital amputations and reamputations on the same limb. Three-quarters of all amputees seen for the first time in England in 1986 (2) were over the age of 60 years and many were in their late seventies and early eighties (Table I). The ratio of male to female amputees is 2.5: 1, becoming closer to parity as age increases. Upper limb amputees are generally found in the younger age groups. The