Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices.
Affiliation
Department of Plastic and Reconstructive Surgery, Cork University Hospital,, Wilton, Ireland.Issue Date
2012-02-03T15:14:31ZMeSH
AdolescentAdult
Aged
*Amputation
Child
Child, Preschool
Evaluation Studies as Topic
Female
Humans
Male
Middle Aged
*Patient Selection
Tibial Fractures/*surgery
*Trauma Severity Indices
Treatment Outcome
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Injury. 1997 Nov-Dec;28(9-10):639-42.Journal
InjuryPubMed ID
9624343Abstract
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
engISSN
0020-1383 (Print)0020-1383 (Linking)
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