Comparing the performance of different open injury scores in predicting salvage and amputation in type IIIB open tibia f
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ORIGINAL PAPER
Comparing the performance of different open injury scores in predicting salvage and amputation in type IIIB open tibia fractures Abhishek Gupta 1 & Sunny Parikh 1 & Raja Bhaskara Rajasekaran 1 & Jayaramaraju Dheenadhayalan 1 & Agraharam Devendra 1 & Shanmuganathan Rajasekaran 1 Received: 4 November 2019 / Accepted: 13 March 2020 # SICOT aisbl 2020
Abstract Background Various open injury scores have been devised to aid the difficult decision of salvage or amputation following open fractures of the lower limb. Our aim of the study was to compare the performance of mangled extremity severity score (MESS), limb salvage index (LSI), orthopaedic trauma association-open fracture classification (OTA-OFC) and Ganga hospital score (GHS) in our population of type IIIB injuries. Materials and methods A total of 219 patients with 225 type IIIB open fractures of the tibia were studied prospectively between July 2016 and June 2017. The decision of salvage or amputation was taken by a combined consensus of senior orthopaedic and plastic surgeons, blinded to the scores. All four open injury scores were calculated by an independent reviewer following initial debridement. The follow-up period was one to two years. Results After final follow-up, there were 193 (85.7%) successfully salvaged limbs, 19 primary amputations without attempt of debridement (8.4%), three primary delayed amputations within 72 hours (1.3%) and six secondary amputations after 72 hours from initial debridement (2.7%). Of these, four patients died within one year and were excluded. All four scores performed well for salvage, while GHS was superior when considering amputation. MESS, LSI and OTA-OFC underscored amputations, since these scoring systems award more points for vascular injuries. There were both salvaged and amputated patients around the threshold value of amputation for all scores, which was only acknowledged by GHS in its unique ‘grey zone’. It includes patients who are neither easily salvageable nor definitely requiring amputation. Conclusion The performance of the GHS was superior to MESS, LSI and OTA-OFC in our study, since it was developed for type IIIB injuries and includes the ‘grey zone’, where decisions need to be undertaken on a case to case basis. Clinical relevance GHS has an improved ability to determine amputation in IIIB open tibia fractures. Keywords Amputation . Salvage . Open injury scores . Ganga hospital open injury score . MESS . OTA-OFC
Introduction Open injuries are often dramatic and present major challenges in the decision of limb salvage versus amputation [1, 2]. The average orthopaedic surgeon in the UK will only see five open long bone fractures annually, of which two will be of the tibial diaphysis and only one will be Gustilo type IIIB [2, 3]. The experience in the management of these injuries of most Level of Evidence: III * Shanmuganathan Rajasekaran [email protected] 1
Ganga Hospital, Coimbatore, Tamil Nadu, India
surgeons, particularly in the decision to salvage or amputate, is thus very lim
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