10. Co-occurring health conditions Sometimes the person might have another health condition that started at the time of the injury but which is not directly related to the amputation (e.g. spinal cord injury). Or the person may have another health condition before the amputation, or may develop a condition after the amputation, that is not independent of the amputation (e.g. diabetes). Similarly, the injury might involve complex orthopaedic injuries that ultimately result in multiple amputations, for example, both lower limbs, or one upper limb and one lower limb. These are referred to as co-occurring health conditions, but in the health sector, they are called co-morbid conditions (see Glossary for the definition of a co-morbid condition). In other circumstances, there is a primary health condition from the trauma and injury (e.g. burns) that is the cause of the amputation (see Glossary for the definition of a primary condition). Many amputations occur as a result of trauma and the associated complications. These co-occurring conditions can have a significant impact on how the person progresses through the support pathway and can influence the supports needed. It is important to provide treatment, rehabilitation and support for these conditions separate to, but alongside, that for the amputation.
10.1 Burns A severe (full thickness) burn, particularly if it is related to electricity or high-voltage power lines (e.g. workplace injury), can lead to an amputation [219-223]. The burn often complicates the recovery, treatment, rehabilitation and support the person needs. All the health professionals in the multidisciplinary team need to understand the complexity of burn injuries and healing from burns. A multidisciplinary approach is important, including input from the appropriate nursing and medical specialists.
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Often a severe burn will require the person to remain in hospital for longer, with a need for more extensive treatment. The problems from burns that require specialist treatment and management include [224]:
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deep tissue damage
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nerve damage or compromised sensation— Grafted skin is thinner and can be more sensitive, but there can also be areas of decreased sensitivity. There can be difficulties with sleeping, compression dressings for the burns, skin breakdowns, or fitting and wearing liners and the prosthesis. There can also be delayed bleeding.
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These concerns can cause complications in fitting the prosthesis or result in changes to the type of prosthesis required (e.g. an upper limb myoelectric prosthesis) [224].
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cognitive impairment—Often the person has experienced a period of unconsciousness at the time of the injury (e.g. electrocution). A large study in rehabilitation inpatients in the USA found that adults with burn injuries (particularly from electricity or high-voltage power lines) have worse memory scores on a cognitive test (Functional Independence Measure [FIM]) than people without burns [225].
infections and wound treatment range of motion limitations (loss of skin stretch or elasticity from skin grafts, or contractures)
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icare Guidance for people with a limb amputation 2021
