Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.
AffiliationDepartment of Plastic and Reconstructive Surgery, Cork University Hospital,, Wilton, Ireland.
Evaluation Studies as Topic
*Trauma Severity Indices
MetadataShow full item record
CitationInjury. 1997 Nov-Dec;28(9-10):639-42.
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.
- The functional outcome of lower-extremity fractures with vascular injury.
- Authors: Lin CH, Wei FC, Levin LS, Su JI, Yeh WL
- Issue date: 1997 Sep
- Third degree open fractures and traumatic sub-/total amputations of the upper extremity: Outcome and relevance of the Mangled Extremity Severity Score.
- Authors: Fochtmann A, Binder H, Rettl G, Starlinger J, Aszmann O, Sarahrudi K, Hajdu S
- Issue date: 2016 Oct
- The effect of systemic injury score on the decision making of mangled lower extremities.
- Authors: Yeh HK, Fang F, Lin YT, Lin CH, Lin CH, Hsu CC
- Issue date: 2016 Oct
- Comparing the performance of different open injury scores in predicting salvage and amputation in type IIIB open tibia fractures.
- Authors: Gupta A, Parikh S, Rajasekaran RB, Dheenadhayalan J, Devendra A, Rajasekaran S
- Issue date: 2020 Sep
- Use of Ganga Hospital Open Injury Severity Scoring for determination of salvage versus amputation in open type IIIB injuries of lower limbs in children-An analysis of 52 type IIIB open fractures.
- Authors: Venkatadass K, Grandhi TSP, Rajasekaran S
- Issue date: 2017 Nov