Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation

Penn-Barwell, Jowan G.; Myatt, R; Bennett, Philippa M.; Sargeant, I.D.; Fries, C. Anton; Kendrew, J.M.; Midwinter, Mark J.; Rickard, Rory F.; Porter, Keith; Rowlands, T K; Mountain, Andrew; Foster, Mark; Stapley, S A; Mortiboy, D.; Bishop, Jonathan

doi:10.1016/j.injury.2014.12.004

Cited by 30 publications

(10 citation statements)

References 19 publications

(15 reference statements)

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“…Though other modifiable risk factors such as limb ischaemic time and transfusion requirement could be examined, the severely injured nature of these casualties would preclude any deviation from established initial treatment algorithms for consideration of the reduction in the risk of later infection. It is also worth noting that it has not been definitively established whether patient-reported outcomes are superior in limb salvage or amputation following severe tibial injury in service personnel [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Factors influencing infection in 10 years of battlefield open tibia fractures

Penn-Barwell

Bennett

Mortiboy

et al. 2016

Strategies in Trauma and Limb Reconstruction

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The aim of this study was to characterise severe open tibial shaft fractures sustained by the UK military personnel over 10 years of combat in Iraq and Afghanistan. The UK military Joint Theatre Trauma Registry was searched for all such injuries, and clinical records were reviewed for all patients. One hundred Gustilo–Anderson III tibia fractures in 89 patients were identified in the 10 year study period; the majority sustained injuries through explosive weapons (63, 68 %) with the remainder being injured from gunshot wounds. Three fractures were not followed up for 12 months and were therefore excluded. Twenty-two (23 %) of the remaining 97 tibial fractures were complicated by infection, with S. aureus being the causative agent in 13/22 infected fractures (59 %). Neither injury severity, mechanism, the use of an external fixator, the need for vascularised tissue transfer nor smoking status was associated with subsequent infection. Bone loss was significantly associated with subsequent infection (p < 0.0001, Fisher’s exact test). This study presents 10 years of open tibial fractures sustained in Iraq and Afghanistan. Most infection in combat open tibia fractures is caused by familiar organisms, i.e. S. aureus. While the overall severity of a casualty’s injuries was not associated with infection, the degree of bone loss from the fracture was.

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Section: Discussionmentioning

confidence: 99%

Factors influencing infection in 10 years of battlefield open tibia fractures

Penn-Barwell

Bennett

Mortiboy

et al. 2016

Strategies in Trauma and Limb Reconstruction

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“…The mean fracture union rate across all 30 papers was 87.6%. The lowest fracture union rates was 50%, 21 and the highest union rates were reported at 100%, observed in 4/30 papers [22][23][24][25] ( Table 1). We used linear regression to test whether non-union rates have changed over time.…”

Section: Keeling Et Al 2008 18 Unionmentioning

confidence: 95%

Fracture union rates across a century of war: a systematic review of the literature

et al. 2020

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IntroductionFractures have been a common denominator of the injury patterns observed over the past century of warfare. The fractures typified by the blast and ballistic injuries of war lead to high rates of bone loss, soft tissue injury and infection, greatly increasing the likelihood of non-union. Despite this, no reliable treatment strategy for non-union exists. This literature review aims to explore the rates of non-union across a century of conflict, in order to determine whether our ability to heal the fractures of war has improved.MethodsA systematic review of the literature was conducted, evaluating the rates of union in fractures sustained in a combat environment over a 100-year period. Only those fractures sustained through a ballistic or blast mechanism were included. The review was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Quality and bias assessment was also undertaken.ResultsThirty studies met the inclusion criteria, with a total of 3232 fractures described across 15 different conflicts from the period 1919–2019. Male subjects made up 96% of cases, and tibial fractures predominated (39%). The lowest fracture union rate observed in a series was 50%. Linear regression analysis demonstrated that increasing years had no statistically significant impact on union rate.ConclusionsFailure to improve fracture union rates is likely a result of numerous factors, including greater use of blast weaponry and better survivability of casualties. Finding novel strategies to promote fracture healing is a key defence research priority in order to improve the rates of fractures sustained in a combat environment.

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“…The only outcomes that differed were that patients who had amputations returned to theatre on average less than those who had limb salvage (5 vs 19.1 respectively), and also had less rehospitalisations. Penn-Barwell et al (38) failed to find a difference at four years between limb salvage patients and amputees with respect to pain and shortfrom 36 scores (physical and mental components). Similar short-form 36 scores were demonstrated recently by Frisvoll et al, who also reported no difference in patient satisfaction scores (39).…”

Section: Outcomes: Limb Salvage Vs Amputationmentioning

confidence: 96%

The mangled extremity: assessment, decision making and outcomes

Sharrock¹

2021

Acta Orthop Belg

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The management of the mangled extremity continues to pose a significant challenge for ortho- paedic trauma surgeons. This article provides a comprehensive, up-to-date literature review on the assessment of complex limb injuries, and the variables that affect decision-making and outcomes in both limb salvage and amputation. Initial assessment involves using a systematic approach, saving life before limb, with early involvement of the relevant surgical specialities and multidisciplinary team. The decision to attempt limb salvage or perform amputation can be extremely difficult. Scoring systems can be used as a guide but should not be wholly relied upon; instead more emphasis should be placed on the surgeon’s experience, extent of soft tissue damage, and patient factors and wishes. Outcomes following amputation versus limb salvage are comparable, with some studies suggesting amputation may be favourable. It is important to advise patients and families on what treatment is in their best interest so they can make an informed decision, and this must utilise a multidisciplinary approach.

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Medium-term outcomes following limb salvage for severe open tibia fracture are similar to trans-tibial amputation

Cited by 30 publications

References 19 publications

Factors influencing infection in 10 years of battlefield open tibia fractures

Factors influencing infection in 10 years of battlefield open tibia fractures

Fracture union rates across a century of war: a systematic review of the literature

The mangled extremity: assessment, decision making and outcomes

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