Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2010 Jun;468(6):1669-75.
doi: 10.1007/s11999-009-1148-4. Epub 2009 Oct 28.

Proximal tibial metaphyseal fractures with severe soft tissue injury: clinical and functional results at 2 years

James S Starman  1 , Renan C Castillo, Michael J Bosse, Ellen J MacKenzie; LEAP Study Group
Affiliations
Comparative Study

Proximal tibial metaphyseal fractures with severe soft tissue injury: clinical and functional results at 2 years

James S Starman et al. Clin Orthop Relat Res. 2010 Jun.

Abstract

Background: Controversy exists regarding management of proximal tibial metaphyseal fractures with severe soft tissue injury. It is unclear whether limb salvage or early amputation results in the best functional and clinical outcomes.

Questions/purpose: We hypothesized that in this group of patients, there is no difference in functional outcomes, complication rates, clinical outcomes, or objective physical function related to the treatment approach.

Methods: We used the LEAP study database to perform a retrospective comparative review of a subset of patients with proximal tibial metaphyseal fractures (AO/OTA 41A, B, and C) with associated severe soft tissue injuries comparing the outcomes of patients who were treated with either limb salvage or amputation.

Results: Although there were major differences in clinical and functional outcomes based on patients' sociodemographics at 2 years, no differences in clinical or functional outcomes were detected regardless of whether amputation or limb salvage was performed. Severity of soft tissue injury was more predictive of outcome than the surgical approach used.

Conclusions: Sociodemographics and soft tissue injury severity are more important than treatment approach for predicting clinical and functional outcomes at 2 years in patients with proximal tibia metaphyseal fractures with severe soft tissue injury.

Level of evidence: Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.

PubMed Disclaimer

References

    1. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981;19:787–805. doi: 10.1097/00005650-198108000-00001. - DOI - PubMed
    1. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, Sanders RW, Jones AL, McAndrew MP, Patterson BM, McCarthy ML, Cyril JK. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am. 2001;83:3–14. doi: 10.1302/0301-620X.83B1.11952. - DOI - PubMed
    1. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, Sanders RW, Jones AL, McAndrew MP, Patterson BM, McCarthy ML, Travison TG, Castillo RC. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347:1924–1931. doi: 10.1056/NEJMoa012604. - DOI - PubMed
    1. Busse JW, Jacobs CL, Swiontkowski MF, Bosse MJ, Bhandari M. Evidence-Based Orthopaedic Trauma Working Group. Complex limb salvage or early amputation for severe lower-limb injury: a meta-analysis of observational studies. J Orthop Trauma. 2007;21:70–76. doi: 10.1097/BOT.0b013e31802cbc43. - DOI - PubMed
    1. Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR. Salvage after severe lower-extremity trauma: are the outcomes worth the means? Plast Reconstr Surg. 1999;103:1212–1220. doi: 10.1097/00006534-199904040-00017. - DOI - PubMed

Publication types

MeSH terms