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. 2017 Oct;103(6):971-975.
doi: 10.1016/j.otsr.2017.05.022. Epub 2017 Jul 14.

Is amputation a viable treatment option in lower extremity trauma?

M Barla  1 , B Gavanier  2 , M Mangin  2 , J Parot  2 , C Bauer  2 , D Mainard  2
Affiliations

Is amputation a viable treatment option in lower extremity trauma?

M Barla et al. Orthop Traumatol Surg Res. 2017 Oct.

Abstract

Introduction: There is currently no consensus on how to treat patients with lower extremity trauma. Should amputation be performed early on to avoid complications or should the limb be saved at any price? The goal of this study was to show that early amputation is a viable treatment option in lower extremity trauma cases.

Material and methods: Twenty patients who underwent early amputation and 16 patients who underwent limb-salvage were included with a minimum follow-up of 1year. The main endpoints were the Mangled Extremity Severity Score (MESS) used to predict amputation, complications, sequelae, bone union and functional outcomes.

Results: The amputees had a higher MESS score than those treated conservatively (7.8 vs. 4.9, P<0.00001), had a shorter hospital stay (P<0.022) and had fewer postoperative complications (P<0.003), especially infection-related (P<0.001). The prevalence of infection in limb-salvage patients was 61%. There was no significant difference between the two groups in terms of quality of life.

Discussion: In cases of lower extremity trauma, early amputation and limb-sparing treatment each have their advantages and disadvantages. Early amputation seems to be better in cases of complications, despite similar quality of life in the two groups in the long-term. It is a viable treatment option in cases of lower extremity trauma. Amputation must not be considered as a failure, but a deliberate choice due to the functional impact of complications that occur after limb-salvage.

Level of evidence: Level IV study.

Keywords: Amputation; Gustilo III; Limb-salvage; Lower extremity trauma.

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