Citation

Sheean AJ, Krueger CA, Napierala MA, Stinner DJ, Hsu JR. J. Orthop. Trauma 2013; 28(9): 523-526.

Affiliation

1San Antonio Military Medical Center, Ft. Sam Houston, TX 2Carolinas Medical Center Orthopaedic Surgery, Charlotte, NC.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000000054

PMID

24378400

Abstract

OBJECTIVES:: The purpose of this study was to determine the extent to which the Mangled Extremity Severity Score (MESS) predicted outcomes for soldiers sustaining combat related Gustilo-Anderson Type III tibia fractures. DESIGN:: Retrospective cohort study SETTING:: Tertiary trauma center PATIENTS/ PARTICIPANTS:: Service Members with combat-related Type III tibia fractures occurring between 2003 and 2007 treated definitively in a US military medical center INTERVENTION:: Amputation or limb salvage MAIN OUTCOME MEASUREMENTS:: MESS, amputation or limb salvage RESULTS:: Complete data were available for 155 patients treated for Type III tibia fractures. One hundred ten patients had salvaged limbs, and 45 patients had lower extremity amputations. The mean MESS values for amputees and patients treated with limb salvage were 5.8 and 5.3 (P < 0.057) respectively. The sensitivity and specificity of a MESS ≥ 7 predicting amputation was 31%, the 87% respectively. A MESS value of ≥ 7 was found to have a positive predictive value on 50%. Thirty three percent of patients treated with amputation had an associated vascular injury versus 12.7% of patients treated with limb salvage (P < 0.0026) DISCUSSION:: There was no significant difference between MESS values of amputees and those treated with limb salvage. Moreover, these data demonstrate that the MESS is neither sensitive nor accurate in predicting amputation.

Language: en