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
Observational Study
. 2021 Sep 1;103(17):1588-1597.
doi: 10.2106/JBJS.20.01320.

Outcomes Following Severe Distal Tibial, Ankle, and/or Mid/Hindfoot Trauma: Comparison of Limb Salvage and Transtibial Amputation (OUTLET)

Major Extremity Trauma Research Consortium (METRC)
Collaborators
Observational Study

Outcomes Following Severe Distal Tibial, Ankle, and/or Mid/Hindfoot Trauma: Comparison of Limb Salvage and Transtibial Amputation (OUTLET)

Major Extremity Trauma Research Consortium (METRC). J Bone Joint Surg Am. .

Abstract

Background: Selecting the best treatment for patients with severe terminal lower-limb injury remains a challenge. For some injuries, amputation may result in better outcomes than limb salvage. This study compared the outcomes of patients who underwent limb salvage with those that would have been achieved had they undergone amputation.

Methods: This multicenter prospective observational study included patients 18 to 60 years of age in whom a Type-III pilon or IIIB or C ankle fracture, a Type-III talar or calcaneal fracture, or an open or closed blast/crush foot injury had been treated with limb salvage (n = 488) or amputation (n = 151) and followed for 18 months. The primary outcome was the Short Musculoskeletal Function Assessment (SMFA). Causal effect estimates of the improvement that amputation would have provided if it had been performed instead of limb salvage were calculated for the SMFA score, physical performance, pain, participation in vigorous activities, and return to work.

Results: The patients who underwent limb salvage would have had small differences in most outcomes had they undergone amputation. The most notable difference was an improvement in the SMFA mobility score of 7 points (95% confidence interval [CI] = 2.0 to 10.7). Improvements were largest for pilon/ankle fractures and complex injury patterns.

Conclusions: Amputation should be considered a treatment option rather than a last resort for the most complex terminal lower-limb injuries.

Level of evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

Disclosure: This study was supported by Department of Defense award number W81XWH-10-2-0090, OUTLET (NCT01606501), and TAOS (NCT01821976). On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and “yes” to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (http://links.lww.com/JBJS/G488).

References

    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 Dec 12;347(24):1924-31.
    1. Ellington JK, Bosse MJ, Castillo RC, MacKenzie EJ; LEAP Study Group. The mangled foot and ankle: results from a 2-year prospective study. J Orthop Trauma. 2013 Jan;27(1):43-8.
    1. Dickens JF, Kilcoyne KG, Kluk MW, Gordon WT, Shawen SB, Potter BK. Risk factors for infection and amputation following open, combat-related calcaneal fractures. J Bone Joint Surg Am. 2013 Mar 6;95(5):e24.
    1. Bevevino AJ, Dickens JF, Potter BK, Dworak T, Gordon W, Forsberg JA. A model to predict limb salvage in severe combat-related open calcaneus fractures. Clin Orthop Relat Res. 2014 Oct;472(10):3002-9.
    1. Bennett PM, Stevenson T, Sargeant ID, Mountain A, Penn-Barwell JG. Outcomes following limb salvage after combat hindfoot injury are inferior to delayed amputation at five years. Bone Joint Res. 2018 Feb;7(2):131-8.

MeSH terms