Farm-related limb amputations in children.

The purpose of this study was to review results for children sustaining traumatic farm-related limb amputations. Farm machinery accidents were responsible for 12 limb amputations among 260 consecutive childhood traumatic amputations. All amputations resulted in open, grade III-C fractures. Treatment consisted of operative debridement, antibiotics, possible replantation, and delayed wound closure. Mean follow-up was 8 years (range 1-20). Wound closure was achieved at a mean of 22 days (range 2-88) after an average of seven operative procedures (range, 2-11 operations). Skin grafting was necessary for 9 of the 12 limbs. Blood replacement was necessary for all but one patient. Initial wound cultures revealed polymicrobial contamination in all patients. Clinical infections developed exclusively and in all (6/6) patients who underwent attempted replantation. Replantation was considered in all cases and was attempted for six limbs but was successful in only two patients. Failure of replantation in four limbs was due to vascular insufficiency and infection. The surviving replanted limbs have continued to grow and have regained protective sensation. Prosthetic use ranges from excellent to intermittent among the 10 patients with permanent amputation. Farm-related limb amputations are among the most severe orthopaedic injuries sustained by children. Despite massive contamination, infection occurred only in replanted limbs. Because of the mutilating nature of these amputations, less than 20% can be successfully replanted.