Outcomes After Severe Distal Tibia, Ankle, and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation (OUTLET)

Bosse, Michael J.; Teague, David; Reider, Lisa; Gary, Joshua L.; Morshed, Saam; Seymour, Rachel B.; Toledano, James; Cannada, Lisa K.; Steverson, Barbara; Scharfstein, Daniel O.; Luly, Jason; MacKenzie, Ellen J.; Metrc,

doi:10.1097/bot.0000000000000799

Cited by 32 publications

(28 citation statements)

References 18 publications

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“…The findings of this study appear to be consistent with the recently reported results of the Outcomes After Severe Distal Tibia, Ankle, and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation trial (OUTLET), a prospective, observational multicentre study of North American civilian patients. 41 , 42 There were 410 patients in the limb salvage group and 87 in the transtibial amputation group who completed the Short Musculoskeletal Function Assessment (SMFA) at 18 months. Patients with reconstructed severe distal tibia, and/or mid- or hindfoot injuries reported significantly poorer scores across most SMFA domains, particularly mobility, compared with those treated with transtibial amputation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Bennett

Stevenson

Sargeant

et al. 2018

Bone & Joint Research

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ObjectivesThe surgical challenge with severe hindfoot injuries is one of technical feasibility, and whether the limb can be salvaged. There is an additional question of whether these injuries should be managed with limb salvage, or whether patients would achieve a greater quality of life with a transtibial amputation. This study aims to measure functional outcomes in military patients sustaining hindfoot fractures, and identify injury features associated with poor function.MethodsFollow-up was attempted in all United Kingdom military casualties sustaining hindfoot fractures. All respondents underwent short-form (SF)-12 scoring; those retaining their limb also completed the American Academy of Orthopaedic Surgeons Foot and Ankle (AAOS F&A) outcomes questionnaire. A multivariate regression analysis identified injury features associated with poor functional recovery.ResultsIn 12 years of conflict, 114 patients sustained 134 fractures. Follow-up consisted of 90 fractures (90/134, 67%), at a median of five years (interquartile range (IQR) 52 to 80 months).The median Short-Form 12 physical component score (PCS) of 62 individuals retaining their limb was 45 (IQR 36 to 53), significantly lower than the median of 51 (IQR 46 to 54) in patients who underwent delayed amputation after attempted reconstruction (p = 0.0351).Regression analysis identified three variables associated with a poor F&A score: negative Bohler’s angle on initial radiograph; coexisting talus and calcaneus fracture; and tibial plafond fracture in addition to a hindfoot fracture. The presence of two out of three variables was associated with a significantly lower PCS compared with amputees (medians 29, IQR 27 to 43 vs 51, IQR 46 to 54; p < 0.0001).ConclusionsAt five years, patients with reconstructed hindfoot fractures have inferior outcomes to those who have delayed amputation. It is possible to identify injuries which will go on to have particularly poor outcomes.Cite this article: P. M. Bennett, T. Stevenson, I. D. Sargeant, A. Mountain, J. G. Penn-Barwell. Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years. Bone Joint Res 2018;7:131–138. DOI: 10.1302/2046-3758.72.BJR-2017-0217.R2.

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Section: Discussionmentioning

confidence: 99%

Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Bennett

Stevenson

Sargeant

et al. 2018

Bone & Joint Research

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“…Selecting limb preservation was an essential issue in the present case, although there are currently no established guidelines for deciding between early amputation and reconstruction for severe lower limb injuries. 6 Given that extensive tissue necrosis even involved the osteomyelitis and caused neurological deficits, it was possible that there was no choice but to amputate. However, considering the patient’s young age and the family’s strong desire, we chose limb reconstruction as the desirable therapeutic option.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction for Severe Extracorporeal Membrane Oxygenation-induced Ischemic Lower Limb Injury Complicated by Osteomyelitis

Hidaka

Kurita

Miyamoto

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Extracorporeal membrane oxygenation (ECMO) is a well-established mechanical circulatory support system used in patients with life-threatening cardiopulmonary conditions. However, severe complications associated with vascular access require consideration. We report a patient with fatal ventricular arrhythmia who was successfully resuscitated with ECMO but who developed severe lower limb ischemia, which resulted in compartment syndrome. Even with emergent fasciotomy, tissue necrosis developed in wide areas of the limb, with subsequent tibial osteomyelitis. After extensive debridement and tibial sequestrectomy, the soft tissue and bone defect were simultaneously reconstructed with free tissue transfer of the latissimus dorsi muscle and scapular tip composite flap. The limb was successfully salvaged with satisfactory functional outcomes without major complications. This report discusses limb reconstruction for ECMO-induced compartment syndrome and illustrates the importance of appropriate selection of reconstruction methods among various composite flaps.

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“…These "parent" studies included 3 studies of very severe, limb-threatening tibia fractures and amputations (FIXIT, OUTLET, and TAOS), 2 studies of slightly less severe lower-limb fractures (OXYGEN and VANCO), and 1 study of isolated, low severity fractures (Pain) all of which have been completed and previously described. [15][16][17][18][19][20] The key characteristics of these studies are shown in Supplemental Digital Content (see Table 1, http://links.lww.com/JOT/B602).…”

Section: Study Participantsmentioning

confidence: 99%

Streamlining Trauma Research Evaluation With Advanced Measurement (STREAM) Study: Implementation of the PROMIS Toolbox Within an Orthopaedic Trauma Clinical Trials Consortium

Carlini

Collins

Staguhn

et al. 2022

Journal of Orthopaedic Trauma

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Information System (PROMIS) has developed item banks, short forms, and computer-adaptive tests (CATs) to help standardize measurement for important patient-reported outcome domains. These tools have the potential to revolutionize outcome measurement in clinical research through greater assessment precision while reducing response burden. Perceived implementation challenges include the need for CAT software, mobile technology, and Internet access. Here, we present preliminary results examining the feasibility of using PROMIS tools within a large, multicenter clinical trials con-sortium. The assessment of 10 PROMIS domains was incorporated into the longitudinal data collection of 6 ongoing orthopaedic trauma clinical trials for participants being evaluated at 3, 6, and 12 months after an orthopaedic injury. Twelve-month assessments included both CAT assessments and completion of full item banks for a subset of domains. Data were collected for 1000 trauma patients at 43 trauma centers using a custom-built application which included an interface with our primary data capture system. Paper short forms were available as backup instruments and used infrequently. Six-and 12-month study assessments were conducted for 83% and 77% of patients, respectively. It was feasible to use PROMIS tools in a large multicenter, trauma orthopaedics research setting. The ability to efficiently assess a wide spectrum of domains is critically important to the successful completion of future large-scale trials.

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Outcomes After Severe Distal Tibia, Ankle, and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation (OUTLET)

Cited by 32 publications

References 18 publications

Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years

Reconstruction for Severe Extracorporeal Membrane Oxygenation-induced Ischemic Lower Limb Injury Complicated by Osteomyelitis

Streamlining Trauma Research Evaluation With Advanced Measurement (STREAM) Study: Implementation of the PROMIS Toolbox Within an Orthopaedic Trauma Clinical Trials Consortium

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