Third degree open fractures and traumatic sub /total amputations of the upper extremity: Outcome and relevance of the Mangled Extremity Severity Score.
INTRODUCTION Third degree open fractures and traumatic sub /total amputations of the upper extremity represent severe injuries and are associated with a high rate of functional impairment of the affected extremity. More than 20 years ago, the Mangled Extremity Severity Score (MESS) was introduced to predict amputation following severe lower extremity trauma. However, there have been few studies evaluating MESS in connection with the mangled upper limb. MATERIAL AND METHODS A retrospective medical chart review was performed of all patients diagnosed with the aforementioned fractures of the upper extremity treated at the Department of trauma surgery (level I trauma center) and the Clinical division of plastic and reconstructive surgery at the general hospital of Vienna between 1994 and 2014. RESULTS Fifty four out of 606 patients (9% suffered from a total of 61 third degree open fractures or traumatic sub /total amputations of the upper extremity (Gustilo Anderson, type IIIA, n=30; Gustilo Anderson, type IIIB, n=15; Gustilo Anderson, type IIIC, n=9; traumatic sub /total amputations, n=7) Thirty seven out of 54 patients (69% suffered fractures of the forearm, 10/54 (19% patients of the humerus and 7/54 (13% patients of the forearm and the humerus. The median MESS and Injury Severity Score (ISS) for all patients was 5 (range: 3 10) and 9 (range: 4 50) respectively. Seventeen out of 54 patients (31% were diagnosed with a MESS>=7. Twenty one out of 54 patients (39% suffered severe vascular injuries and 22/54 (41% patients suffered injuries of neural structures. Throughout the therapy process, 6/54 (11% patients died. Definite limb salvage was achieved in 45 (94% of the 48 survivors, of whom 9/45 (20% subjects had a MESS>=7. DISCUSSION It became apparent that definite limb salvage could be achieved in the mangled upper extremity regardless of MESS. It should be noted that in the current study, limb functionality was not assessed. However, without a standardized scoring system, there might be significant risk of salving dysfunctional upper limbs. LEVEL OF EVIDENCE IV: retrospective or historical series.
Orthopaedics traumatology, surgery research OTSR