Early One Stage Functional Reconstruction of a Mangled Upper Extremity.

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Abstract

Conflict of interest statement: Conflict of interestDr Debarati Chattopadhyay has no conflict of interest, Dr Akshay Kapoor has no conflict of interest, Dr Praveen A Jayaprakash has no conflict of interest, Dr Tarun Goyal has no conflict of interest 14. Bone Joint J. 2021 Apr;103-B(4):769-774. doi: 10.1302/0301-620X.103B4.BJJ-2020-1647.R1. Outcomes of severe lower limb injury with Mangled Extremity Severity Score ≥ 7. Hoogervorst LA(1)(2), Hart MJ(2)(3), Simpson PM(2), Kimmel LA(2)(4), Oppy A(3)(5), Edwards ER(2)(6), Gabbe BJ(2)(7). Author information: (1)Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, the Netherlands. (2)School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. (3)Orthopaedic Surgery Department, Royal Melbourne Hospital, Melbourne, Australia. (4)Physiotherapy Department, The Alfred, Melbourne, Australia. (5)Department of Surgery, The University of Melbourne, Melbourne, Australia. (6)Orthopaedic Surgery Department, The Alfred, Melbourne, Australia. (7)Health Data Research UK, Swansea University Medical School, Swansea, UK. AIMS: Complex fractures of the femur and tibia with associated severe soft tissue injury are often devastating for the individual. The aim of this study was to describe the two-year patient-reported outcomes of patients in a civilian population who sustained a complex fracture of the femur or tibia with a Mangled Extremity Severity Score (MESS) of ≥ 7, whereby the score ranges from 2 (lowest severity) to 11 (highest severity). METHODS: Patients aged ≥ 16 years with a fractured femur or tibia and a MESS of ≥ 7 were extracted from the Victorian Orthopaedic Trauma Outcomes Registry (January 2007 to December 2018). Cases were grouped into surgical amputation or limb salvage. Descriptive analysis were used to examine return to work rates, three-level EuroQol five-dimension questionnaire (EQ-5D-3L), and Glasgow Outcome Scale-Extended (GOS-E) outcomes at 12 and 24 months post-injury. RESULTS: In all, 111 patients were included: 90 (81%) patients who underwent salvage and 21 (19%) patients with surgical amputation. The mean age of patients was 45.8 years (SD 15.8), 93 (84%) were male, 37 (33%) were involved in motor vehicle collisions, and the mean MESS score was 8.2 (SD 1.4). Two-year outcomes in the cohort were poor: six (7%) patients achieved a GOS-E good recovery, the mean EQ-5D-3L summary score was 0.52 (SD 0.27), and 17 (20%) patients had returned to work. CONCLUSION: A small proportion of patients with severe lower limb injury (MESS ≥ 7) achieved a good level of function 24 months post-injury. Further follow-up is needed to better understand the long-term trajectory of these patients, including delayed amputation, hospital readmissions, and healthcare utilization. Cite this article: Bone Joint J 2021;103-B(4):769-774. DOI: 10.1302/0301-620X.103B4.BJJ-2020-1647.R1