Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage

Ly, Thuan V.; Travison, Thomas G.; Castillo, Renan C.; Bosse, Michael J.; MacKenzie, Ellen J.

doi:10.2106/jbjs.g.00136

Cited by 173 publications

(71 citation statements)

References 17 publications

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“…Intuitively, patients with more severe injuries would be expected to have a lower rate of return to work. However, Ly, et al could clearly demonstrate that lower extremity severity scoring systems are not predictive of functional recovery in patients with successful limb reconstruction [21]. The patients in this case series were referred for definitive treatment; the severity of the initial injury is therefore unknown, but it is unlikely the severity of that injury or the multiple procedures prior to referral have influenced outcomes.…”

Section: Discussionmentioning

confidence: 75%

“…Advances in orthopaedic, vascular, and plastic surgery have made it possible to treat severely injured lower limbs with salvage procedures [5,21]. However, limb salvage may not be in the patient's best interest as it is commonly associated with higher rates of rehospitalization, more surgical procedures, and a higher rate of complications when compared to primary amputation [7].…”

Section: Introductionmentioning

confidence: 99%

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Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Merwe

Birkholtz

Tetsworth

et al. 2016

Injury

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Purpose:The purpose of this study was to evaluate the functional and psychological outcomes of patients who underwent delayed lower limb amputation following failed limb salvage surgery. Methods:This retrospective, descriptive study evaluated functional outcomes using the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) in 12 patients. Inclusion criteria included patients who underwent limb reconstruction and delayed amputation between between July 2006 and December 2014, with an age range between 18-80 years of age, the ability to ambulate independently, a time interval between the last salvage procedure and amputation greater than six months, and a minimum follow-up of 24 months. Patients were contacted via telephone by the principal investigator and both the Sickness Impact Profile (SIP) and Short Form-36 (SF-36) were completed. Descriptive analysis (means and standard deviation) was used to determine outcomes for both SIP and SF-36 health profiles. Results:Ten patients who had amputations following failed reconstruction (2006-2014) with a mean age of 53+10 years were interviewed. Six patients had a SIP < 5, three patients scored between five and 10 points and one scored >10 points. The main deficit on the SF-36 was in the physical component. The SF-36 scores demonstrated a mean score of 40.8+11.5 for the physical component, and 57.4+7.9 for the mental component. Three patients returned to work after amputation and continued performing their pre-injury duties as farmers.Three other patients returned to work, but were allocated to administrative duties. Two patients were pensioners at the time of their injuries, and the only female patient was a housewife. One patient went into early retirement. Conclusion:The results of this study strongly suggest that delayed amputation following failed limb salvage surgery can still result in good and satisfactory outcomes in the majority of patients and achieves results similar to early amputation and limb reconstruction techniques.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Merwe

Birkholtz

Tetsworth

et al. 2016

Injury

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“…Recent studies have insisted on reconstruction attempts of the limb and deferred amputations [9] . As we used MESS as primary screening to predict the requirement of limb salvage, the literature however suggests that no single parameter or score is predictive of outcome [10] . Rehabilitation, prosthesis expenditure and psychological trauma are another issues worth consideration that were not covered in our study and require another study.…”

Section: Discussionmentioning

confidence: 99%

Incidence and type of complications following traumatic extremity amputations: preliminary report from a teaching hospital

Dharmshaktu¹,

Singh²,

Bhandari³

et al. 2018

Int. J. Orthop. Sci.

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Amputation is one of the oldest surgical procedure and a good amputation results in optimal functional outcome by providing healthy residual limb. Advances in prosthetics has enabled amputee with diverse options and better functionality. There is also decrease in the overall burden of amputation as a result of better treatment of causative disorders and proper limb salvage techniques. Complications, however, pose challenges in regain of necessary functions and include an array of disorders related to the procedure, technique and other factors. An understanding of common and practical complications is helpful in their anticipation and relevant prohibitive measures. Apart from it, a comprehensive study that highlights pattern of amputations and related complications provides database for preventive and management strategy. A total of 69 cases of extremity amputations were included within a defined period of Jan 2011 to June 2016. Relevant demographic data were noted along with other details amputation and complications. An attempt is also made for co-morbidities associated in cases with complications. Males (88.40%) and lower extremity (66.66%) were involved more commonly than females and upper extremity. Below knee was commonest (50.72%) lower and below elbow along with digital amputations were commonest (15.94% each) upper extremity amputations. The significant complication that required increased hospital stay or additional procedures were noted in 34 (49.27%) cases. Delayed wound healing, wound dehiscence, painful neuroma, stiffness, exposed bone and phantom pain were some of major complication noted in the study. A brief notes on patient characteristics has been attributed to the nature of trauma, co-morbidities and substance abuse among the complicated cases. The early recognition of complication and prompt management goes a long way in abetment of agony and discomfort of patient affecting overall outcome.

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“…According to Slauterbeck et al, [6] MESS scoring is as a good predictor for amputation in the upper extremity injuries. [5,[13][14][15] However, clinical experience and the skills of the surgeon are more critical than the scoring systems in the upper extremity crush injuries. [6,8,[15][16][17][18] This is probably the result of several contributing factors.…”

Section: Discussionmentioning

confidence: 99%

Histopathological evaluation of the arterial wall damage in upper limb injuries

Özçınar¹

2017

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada, üst ekstremite ezilme yaralanmaları arter duvarındaki histopatolojik değişikliklere göre değerlendirildi ve erken ve geç dönem klinik sonuçlar bildirildi.Ça lış ma pla nı: Şubat 2011 -Kasım 2013 tarihleri arasında üst ekstremite ezilme yaralanması olan 12 hastanın (9 erkek, 3 kadın; ort. yaş 33.3±11.7 yıl; dağılım 18-57 yıl) prospektif olarak toplanan verileri retrospektif olarak incelendi. Hastaların tümünün Ezilmiş Ekstremite Şiddet Skoru ≥7 idi ve tümünde ciddi vasküler yaralanma bulguları vardı. Ortopedik stabilizasyon sonrasında vasküler rekonstrüksiyon yapıldı. Hemodinamik stabilizasyon sonrasında, rutin olarak dijital substraksiyon anjiyografi çekildi. Revaskülarizasyon işlemi sırasında, hasarlı arter damarları çıkarıldı ve formalin solüsyonunda saklandı. Endotelyal şişme, intimal kalınlaşma, kas tabakasındaki hücresel vaküolizasyon, tunika medyadaki ödem ve nekrozun derecesi değerlendirildi.Bul gu lar: Yaralanma beş hastada işe bağlı kazalar ve yedi hastada motorlu araç kazaları ile ilişkiliydi. Tüm hastalara ven greft interpozisyonu uygulandı (12; %100). Primer açıklık oranı %75 idi ve bir hasta kaybedildi (30 günlük mortalite %8.3). On iki hastada üç amputasyon yapıldı. Medyan takip süresi 3.2 (dağılım: 2.1-3.7) yıl idi. Alınan örneklerin mikroskopik incelemesinde vasküler konjesyon ve trombüs oluşumu, ilerleyici subintimal diseksiyon ve elastik internanın membranında yırtılma olduğu belirlendi.So nuç: Çalışma sonuçlarımız Ezilmiş Ekstremite Şiddet Skoruna göre amputasyon endikasyonu olsa da, ekstremite kurtarma işlemlerinin uygulanmasını önermektedir.Anah tar söz cük ler: Ezilme yaralanması; patolojik değerlendirme; üst ekstremite revaskülarizasyonu. ABSTRACTBackground: This study aims to evaluate the upper limb crush injuries according to the histopathological changes in the arterial vessel and to report the early and late clinical outcomes.

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Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage

Abstract: Background: Lower-extremity injury severity scoring systems were developed to assist surgeons in decision-making

Cited by 173 publications

References 17 publications

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Functional and psychological outcomes of delayed lower limb amputation following failed lower limb reconstruction

Incidence and type of complications following traumatic extremity amputations: preliminary report from a teaching hospital

Histopathological evaluation of the arterial wall damage in upper limb injuries

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