118: Upper Limb Amputations

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CHAPTER 118

Upper Limb Amputations

Timothy R. Dillingham, MD, MS; Diane W. Braza, MD

Synonyms

Hand amputations

Below-elbow amputations

Above-elbow amputations

ICD-9 Codes

886  Traumatic amputation of other finger(s) (complete) (partial)

886.0   Without mention of complication

886.1   Amputated finger, complicated

887  Traumatic amputation of arm and hand (complete) (partial)

887.0   Unilateral, below elbow, without mention of complication

887.1   Unilateral, below elbow, complicated

887.2   Unilateral, at or above elbow, without mention of complication

887.3   Unilateral, at or above elbow, complicated

887.4   Unilateral, level not specified, without mention of complication

887.5   Unilateral, level not specified, complicated

887.6   Bilateral (any level), without mention of complication

887.7   Bilateral (any level), complicated

905.9   Late effect of traumatic amputation

997.60  Amputation stump complication, unspecified

997.61  Neuroma of amputation stump

997.62  Infection (chronic) of amputated stump

V52    Fitting and adjustment of prosthetic device and implant

V52.0   Artificial arm (complete) (partial)

ICD-10 Codes

S68.110  Complete traumatic metacarpophalangeal amputation of right index finger

S68.111  Complete traumatic metacarpophalangeal amputation of left index finger

S68.112  Complete traumatic metacarpophalangeal amputation of right middle finger

S68.113  Complete traumatic metacarpophalangeal amputation of left middle finger

S68.114  Complete traumatic metacarpophalangeal amputation of right ring finger

S68.115  Complete traumatic metacarpophalangeal amputation of left ring finger

S68.116  Complete traumatic metacarpophalangeal amputation of right little finger

S68.117  Complete traumatic metacarpophalangeal amputation of left little finger

S68.118  Complete traumatic metacarpophalangeal amputation of other finger

S68.119  Complete traumatic metacarpophalangeal amputation of unspecified finger

S68.120  Partial traumatic metacarpophalangeal amputation of right index finger

S68.121  Partial traumatic metacarpophalangeal amputation of left index finger

S68.122  Partial traumatic metacarpophalangeal amputation of right middle finger

S68.123  Partial traumatic metacarpophalangeal amputation of left middle finger

S68.124  Partial traumatic metacarpophalangeal amputation of right ring finger

S68.125  Partial traumatic metacarpophalangeal amputation of left ring finger

S68.126  Partial traumatic metacarpophalangeal amputation of right little finger

S68.127  Partial traumatic metacarpophalangeal amputation of left little finger

S68.128  Partial traumatic metacarpophalangeal amputation of other finger

S68.129  Partial traumatic metacarpophalangeal amputation of unspecified finger

S48.911  Complete traumatic amputation of right shoulder and upper arm, level unspecified

S48.912  Complete traumatic amputation of left shoulder and upper arm, level unspecified

S48.919  Complete traumatic amputation of unspecified shoulder and upper arm, level unspecified

S48.921  Partial traumatic amputation of right shoulder and upper arm, level unspecified

S48.922  Partial traumatic amputation of left shoulder and upper arm, level unspecified

S48.929  Partial traumatic amputation of unspecified shoulder and upper arm, level unspecified

S58.011  Complete traumatic amputation at elbow level, right arm

S58.012  Complete traumatic amputation at elbow level, left arm

S58.019  Complete traumatic amputation at elbow level, unspecified arm

S58.021  Partial traumatic amputation at elbow level, right arm

S58.022  Partial traumatic amputation at elbow level, left arm

S58.029  Partial traumatic amputation at elbow level, unspecified arm

S58.111  Complete traumatic amputation at level between elbow and wrist, right arm

S58.122  Complete traumatic amputation at level between elbow and wrist, left arm

S58.119  Complete traumatic amputation at level between elbow and wrist, unspecified arm

T87.9 Unspecified complication of amputation stump

T14.8 Other injury of unspecified body region

T87.30   Neuroma of amputation stump, unspecified extremity

T87.31   Neuroma of amputation stump, right upper extremity

T87.32   Neuroma of amputation stump, left upper extremity

T87.33   Neuroma of amputation stump, right lower extremity

T87.34   Neuroma of amputation stump, left lower extremity

T87.40   Infection of amputation stump, unspecified extremity

Z44.9 Encounter for fitting and adjustment of unspecified external prosthetic device

Z44.011  Encounter for fitting and adjustment of complete right artificial arm

Z44.012  Encounter for fitting and adjustment of complete left artificial arm

Z44.019  Encounter for fitting and adjustment of complete artificial unspecified arm

Z44.021  Encounter for fitting and adjustment of partial artificial right arm

Z44.022  Encounter for fitting and adjustment of partial artificial left arm

Z44.029  Encounter for fitting and adjustment of partial artificial unspecified arm

Definition

Upper limb amputations are devastating occurrences for individuals, with profound functional and vocational consequences. In the United States, overall, there are approximately 1.7 million people living with a limb loss, or approximately 1 of every 200 people [1]. In contrast to lower limb loss, upper extremity amputation is much less frequent, affecting approximately 41,000 persons, or about 3% of the U.S. amputee population [2]. The primary reason for upper limb loss is trauma; cancer is the next most common reason [24]. The rates for traumatic amputations declined by 50% during the period 1988 to 1996 [3], probably because of changing work force patterns and greater concerns for industrial safety. However, as a result of the recent wars in Afghanistan and Iraq, the number of catastrophic injuries due to explosive devices has increased [5]. Traumatic amputation is the major reason for upper extremity loss in the military [5]. As of September 2010, 21% of major limb loss sustained in Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom involved the upper extremity [5,6]. As of September 2010, there were 1219 major limb and 399 partial limb amputations [6].

Upper limb amputations from trauma occur at a rate of 3.8 individuals per 100,000; finger amputations are the most common (2.8 per 100,000). Hand amputations from trauma occur at a rate of 0.02 per 100,000 [3]. Traumatic transradial amputations occur at a rate of 0.16 per 100,000 persons, and transhumeral limb loss from trauma occurs at a rate of 0.1 per 100,000 [3].

Limb amputations that result from malignant neoplasms have declined approximately 42% from 1988 to 1996 [3]. Their rates of occurrence are lower than for trauma, with an upper limb loss rate in 1996 of 0.09 per 100,000 [3]. These rates of upper limb amputations are lower than the incidence rates of lower limb dysvascular amputations due to diabetes and peripheral arterial diseases, which occur in 45 per 100,000 individuals and disproportionately affect minority individuals [3,7].

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