Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.

Hdl Handle:
http://hdl.handle.net/10147/209185
Title:
Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.
Authors:
O'Sullivan, S T; O'Sullivan, M; Pasha, N; O'Shaughnessy, M; O'Connor, T P
Affiliation:
Department of Plastic and Reconstructive Surgery, Cork University Hospital,, Wilton, Ireland.
Citation:
Injury. 1997 Nov-Dec;28(9-10):639-42.
Journal:
Injury
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/209185
PubMed ID:
9624343
Abstract:
The patient with severe lower limb trauma presents a management dilemma; whether to amputate primarily or to attempt limb salvage. In recent years, many predictive indices have been published which purport to identify limbs which are non-viable. We retrospectively applied two recently described indices, the Mangled Extremity Severity Score (MESS) and the Limb Salvage Index (LSI), to 54 limbs in 50 patients with either Gustilo IIIB or IIIC complex tibial fractures. There were 22 amputations (40.7 per cent) in the series. The mean MESS score in the limb salvage group was 3.8 (range 2-10), and the mean MESS score in the amputation group was 7.7 (range 4-13) (P < 0.0001). The mean LSI score in the limb salvage group was 3.6 (range 3-8), and the mean LSI score in the amputation group was 6.9 (P < 0.01). However, in the group with MESS scores > 7 (which recommends amputation), there were three limbs which were salvaged with acceptable functional outcome. Similarly, in those with LSI scores > 6 (which recommends amputation), there were seven limbs successfully salvaged. A MESS > 7 offered a greater relative risk of amputation (9.2) than a LSI score > 6 (5.3). We found both indices of use in predicting limb salvage and functional outcome. However, neither is sufficiently accurate to be considered absolutely reliable in clinical practice.
Language:
eng
MeSH:
Adolescent; Adult; Aged; *Amputation; Child; Child, Preschool; Evaluation Studies as Topic; Female; Humans; Male; Middle Aged; *Patient Selection; Tibial Fractures/*surgery; *Trauma Severity Indices; Treatment Outcome
ISSN:
0020-1383 (Print); 0020-1383 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorO'Sullivan, S Ten_GB
dc.contributor.authorO'Sullivan, Men_GB
dc.contributor.authorPasha, Nen_GB
dc.contributor.authorO'Shaughnessy, Men_GB
dc.contributor.authorO'Connor, T Pen_GB
dc.date.accessioned2012-02-03T15:14:31Z-
dc.date.available2012-02-03T15:14:31Z-
dc.date.issued2012-02-03T15:14:31Z-
dc.identifier.citationInjury. 1997 Nov-Dec;28(9-10):639-42.en_GB
dc.identifier.issn0020-1383 (Print)en_GB
dc.identifier.issn0020-1383 (Linking)en_GB
dc.identifier.pmid9624343en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209185-
dc.description.abstractThe patient with severe lower limb trauma presents a management dilemma; whether to amputate primarily or to attempt limb salvage. In recent years, many predictive indices have been published which purport to identify limbs which are non-viable. We retrospectively applied two recently described indices, the Mangled Extremity Severity Score (MESS) and the Limb Salvage Index (LSI), to 54 limbs in 50 patients with either Gustilo IIIB or IIIC complex tibial fractures. There were 22 amputations (40.7 per cent) in the series. The mean MESS score in the limb salvage group was 3.8 (range 2-10), and the mean MESS score in the amputation group was 7.7 (range 4-13) (P < 0.0001). The mean LSI score in the limb salvage group was 3.6 (range 3-8), and the mean LSI score in the amputation group was 6.9 (P < 0.01). However, in the group with MESS scores > 7 (which recommends amputation), there were three limbs which were salvaged with acceptable functional outcome. Similarly, in those with LSI scores > 6 (which recommends amputation), there were seven limbs successfully salvaged. A MESS > 7 offered a greater relative risk of amputation (9.2) than a LSI score > 6 (5.3). We found both indices of use in predicting limb salvage and functional outcome. However, neither is sufficiently accurate to be considered absolutely reliable in clinical practice.en_GB
dc.language.isoengen_GB
dc.subject.meshAdolescenten_GB
dc.subject.meshAdulten_GB
dc.subject.meshAgeden_GB
dc.subject.mesh*Amputationen_GB
dc.subject.meshChilden_GB
dc.subject.meshChild, Preschoolen_GB
dc.subject.meshEvaluation Studies as Topicen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.mesh*Patient Selectionen_GB
dc.subject.meshTibial Fractures/*surgeryen_GB
dc.subject.mesh*Trauma Severity Indicesen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleIs it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.en_GB
dc.contributor.departmentDepartment of Plastic and Reconstructive Surgery, Cork University Hospital,, Wilton, Ireland.en_GB
dc.identifier.journalInjuryen_GB
dc.description.provinceMunster-

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