Is lower limb salvage worthwhile after severe open tibial fractures in a developing country? An analysis of surgical outcomes, quality of life and cost implications

Sethuraman, Arvinth Shivaa; Devendra, Agraharam; Rajasekaran, Raja Bhaskara; Garg, Ankit Kumar; Patel, Yogin; Jayaramaraju, Dheenadhayalan; Venkatramani, Hari; Sabapathy, S. Raja; Rajasekaran, Shanmuganathan

doi:10.1016/j.injury.2020.12.027

Cited by 2 publications

(9 citation statements)

References 21 publications

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“…15 Similarly, patients with amputations scored significantly lower on both 12-Item Short Form Health Survey (SF-12) 24 composite physical and mental health scores and had lower EuroQol five-dimension health questionnaire (EQ-5D) 25 quality of life indices than those with salvaged limbs. 14 Messner et al 16 showed that despite good clinical outcomes, open fractures in children had lasting impact on function and quality of life, and potential for long-term psychological problems. Sethuraman et al 14 observed that the upfront cost of treatment for patients with limb salvage is higher than for amputees.…”

Section: Resultsmentioning

confidence: 99%

“…14 Messner et al 16 showed that despite good clinical outcomes, open fractures in children had lasting impact on function and quality of life, and potential for long-term psychological problems. Sethuraman et al 14 observed that the upfront cost of treatment for patients with limb salvage is higher than for amputees. 14 Risk of bias assessment.…”

Section: Resultsmentioning

confidence: 99%

“…Sethuraman et al 14 observed that the upfront cost of treatment for patients with limb salvage is higher than for amputees. 14 Risk of bias assessment. Quality assessments were presented as a risk of bias and applicability summary (Figure 4) and graph (Supplementary Figure d).…”

Section: Resultsmentioning

confidence: 99%

“…Functional limitations imposed by amputation may be less incapacitating in the developed world on account of high-functioning protheses, and the lifetime costs more affordable secondary to effective healthcare and social insurance systems. 14 However, a meta-analysis of amputation versus limb salvage in mangled lower limb injuries in the developed world setting demonstrated that limb salvage ensured superior psychological outcomes compared with amputation, without significant difference in physical morbidity. 39 Ultimately, the GHOISS, and its high specificity with very narrow confidence intervals, is aptly suited for use in developing nations, where amputation is taboo.…”

Section: Discussionmentioning

confidence: 99%

“…Heterogeneity among studies was visually inspected employing forest plots, and three studies that were primarily designed to investigate specific secondary outcomes were outliers due to patient selection bias. [14][15][16] One study did not report amputations and excluded an unspecified number of patients, the second study excluded amputations, and the third only included patients who had attended follow-up appointments. The remaining five studies evaluated patients with severe complex limb injuries, presenting directly to a tertiary centre, within the first 24 hours of injury after traditional resuscitation.…”

Section: Methodsmentioning

confidence: 99%

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Clinical effectiveness of the Ganga Hospital Open Injury Severity Score for limb salvage versus amputation in patients with complex limb injuries

Ndlovu

Naqshband

Masunda

et al. 2023

The Bone & Joint Journal

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Aims Clinical management of open fractures is challenging and frequently requires complex reconstruction procedures. The Gustilo-Anderson classification lacks uniform interpretation, has poor interobserver reliability, and fails to account for injuries to musculotendinous units and bone. The Ganga Hospital Open Injury Severity Score (GHOISS) was designed to address these concerns. The major aim of this review was to ascertain the evidence available on accuracy of the GHOISS in predicting successful limb salvage in patients with mangled limbs. Methods We searched electronic data bases including PubMed, CENTRAL, EMBASE, CINAHL, Scopus, and Web of Science to identify studies that employed the GHOISS risk tool in managing complex limb injuries published from April 2006, when the score was introduced, until April 2021. Primary outcome was the measured sensitivity and specificity of the GHOISS risk tool for predicting amputation at a specified threshold score. Secondary outcomes included length of stay, need for plastic surgery, deep infection rate, time to fracture union, and functional outcome measures. Diagnostic test accuracy meta-analysis was performed using a random effects bivariate binomial model. Results We identified 1,304 records, of which six prospective cohort studies and two retrospective cohort studies evaluating a total of 788 patients were deemed eligible for inclusion. A diagnostic test meta-analysis conducted on five cohort studies, with 474 participants, showed that GHOISS at a threshold score of 14 has a pooled sensitivity of 93.4% (95% confidence interval (CI) 78.4 to 98.2) and a specificity of 95% (95% CI 88.7 to 97.9) for predicting primary or secondary amputations in people with complex lower limb injuries. Conclusion GHOISS is highly accurate in predicting success of limb salvage, and can inform management and predict secondary outcomes. However, there is a need for high-quality multicentre trials to confirm these findings and investigate the effectiveness of the score in children, and in predicting secondary amputations. Cite this article: Bone Joint J 2023;105-B(1):21–28.

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