Background:The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS) in severely injured lower limbs.Materials and Methods:Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed.Results:In the retrospective study 4.65 (4.65 ± 1.32) was the mean score for the salvaged limbs and 8.80 (8.8 ± 1.4) for the amputated limbs. In the prospective study 4.53 (4.53 ± 2.44) was the mean score for the salvaged limbs and 8.83 (8.83 ± 2.34) for the amputated limbs. There was a significant difference in the mean scores for salvaged and amputated limbs. Retrospective 21 (84%) and prospective 29 (80.5%) limbs remained in the salvage pathway six months after the injury.Conclusion:MESS could predict amputation of severely injured lower limbs, having score of equal or more than 7 with 91% sensitivity and 98% specificity. There was a significant difference in the mean MESS scores in the prospective study (n=36), 4.53 (4.53 ± 2.44) in thirty salvaged limbs (83.33%) and 8.83 (8.83 ± 2.34) in six amputated limbs (16.66%) with a P-value 0.002 (P-value < 0.01). Similarly there was a significant difference in the mean MESS score in the retrospective study (n=25), 4.65 (4.65 ± 1.32) in twenty salvaged limbs (80%) and 8.80 (8.8 ± 1.4) in five amputated limbs (20%) with a P-value 0.00005 (P-value < 0.01). MESS is a simple and relatively easy and readily available scoring system which can help the surgeon to decide the fate of the lower extremity with a high-energy injury.

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Study DesignProspective study.PurposeThe aim of the study was to present long-term results from a 10-year follow-up after endoscopic lumbar discectomy (ELD) by "Destandau's technique".Overview of LiteratureEndoscopic disc surgery by Destandau's technique using ENDOSPINE Karl Storz system is a relatively new technique. It was introduced in 1993. It has been gaining popularity among the spine surgeons, as it is attractive for small skin incision and allows a gentle and excellent tissue dissection with excellent visualization. Many authors have published results of their own studies; however, in all these studies the long-term follow up of the patients has not been emphasized.MethodsA total of 21 patients selected on basis of strict inclusion criteria's underwent ELD from November 2004 to March 2005. Surgery outcome was assessed by using "Prolo's Anatomic-Functional-Economic Rating System" (1986). Patients were followed up to 10 years. In addtion, we compared the results of our study with other studies.ResultsOutcomes were excellent in 17 patients (80.95%), good in 3 (14.28%) and fair in 1 (4.78%), with no patients having a poor result. In our study, 19 patients (90.47%) were able to resume their previous works/jobs, and only 2 (9.52%) needed to change their jobs for lighter work. No patient retired from his or her previous daily routine following the operation.ConclusionsThe initial and long-term results are very good for endoscopic lumbar discectomy by Destandau's technique. In properly selected patients it is a safe and minimally invasive technique, and we recommend ELD in properly selected patients.

Background: Fractures of the clavicle account for 2.6% to 4% of all fractures. Operative management of displaced fractures of the midshaft clavicle is preferred due to better outcomes. Various plates are used for fixation of these fractures, which include reconstruction plates, dynamic compression plates, and precontoured locking plates. Very few studies have documented whether the proposed benefits of precontoured plates are realized in a clinical setting. In this study, we compared the outcomes and complications of displaced midshaft clavicular fractures fixed using precontoured and reconstruction plates. Methods: Patients with Robinson Type 2B fractures of the clavicle treated using reconstruction plates (46 patients) or precontoured plates (68 patients) were included in the study. Parameters such as duration of surgery, functional outcome at 6 mo, and occurrence of complications, such as nonunion, infection, hardware prominence, and overall reoperation rates, were compared between the two groups. Results: There was no significant difference in functional outcomes between the reconstruction plate group and precontoured plate group (Constant score: 85.23 vs. 86.75, respectively). However significantly higher rate of hardware prominence (32.6% vs. 7.3%, respectively), implant removal (15.2% vs. 2.9%, respectively), and reoperation (19.5% vs. 4.4%, respectively) was found with reconstruction plates compared to precontoured plates. Conclusions: The treatment of displaced midshaft clavicular fractures with either reconstruction plates or precontoured plates offers a return to excellent shoulder function. However, a significant decrease in duration of surgery, hardware prominence, and reoperation rate was seen with precontoured plates.

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