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M, Fagelman; Epps, Howard R.; Rang, Mercer

doi:10.1097/00004694-200203000-00009

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…Behdad et al [ 20 ] evaluated 200 children with lower extremity long bone open fracture using MESS score, the Authors described a sensitivity of 73 % and a specificity of 54 % for a MESS ≥ 6.5. Fagelman et al [ 25 ] described an accurate prediction of 93 % when MESS is applied to grade III lower extremity fracture in children. Mommsen et al [ 26 ] analyzed 27 lower extremities in children.…”

Section: Resultsmentioning

confidence: 99%

Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system

Schirò

Sessa

Piccioli

et al. 2015

BMC Musculoskelet Disord

107

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BackgroundIn the last decades a lot of new reconstructive techniques were developed for the treatment of mangled lower extremity. However failed attempt to limb salvage is related to high risk of mortality for the patient. Several scores were developed to establish guidelines for the decision to amputate or not, however in literature there is no consensus about the reliability of this scores.MethodsThe authors focused their attention on the most used score system to provide guidance of the management of a mangled lower limb. The search term used included mangled lower extremity, MESS, PSI, LSI and NISSSA. The inclusion criteria were: studies dealing with mangled lower extremity; articles reporting MESS, PSI, LSI or NISSSA scores; articles published in English in PubMed, Cochrane, Scopus and web of science in the last 30 years, minimum number of cases in study of 15, minimum follow up of 1 year.ResultsAccording with the criteria described above, we found 134 articles in PubMed, 165 articles in Scopus, 111 articles in the Cochrane Library and 108 articles in Web of Science. The most used score in literature is the MESS. Few results are shown using the other severity scores. There are a lot of controversies in literature about the use of this scale. MESS seems to be more accurate than the LSI in prediction of limb salvage. LSI score shows better results when applied to type III tibial fractures. High sentivity of the PSI score is described when applied to predict successful limb salvage. Low sensitivity and specificity are described for the NISSSA score. The literature is very poor of articles related to mangled lower extremity in children. Higher sensitivity and specificity are described for these scores in children when compared to adult population.ConclusionThe mangled lower extremity treatment is a challenge for the surgeon. Many scores were developed to help the surgeon, however they cannot be used as the sole criterion by which amputation decision are made and, in case of succesful limb salvage, they are not predictive of the functional recovery. Moreover, undue enthusiasm for new surgical techniques can lead to increased morbidity and mortality in case of secondary amputation.

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Section: Resultsmentioning

confidence: 99%

Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system

Schirò

Sessa

Piccioli

et al. 2015

BMC Musculoskelet Disord

107

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“…Furthermore, among the patients subjected to amputation, 75% of their fractures were classified as type IIIC and 25% as type IIIB of Gustilo and Anderson. Fagelman et al 16 evaluated the correlation between fractures of Gustilo and Anderson types IIIB and IIIC and the MESS index for exposed fractures of the lower limbs and found results that significantly predicted treatment, for 93%. On the other hand, Sheean et al 17 did not find any significant difference in MESS values between amputees and patients whose limbs were salvaged.…”

Section: Discussionmentioning

confidence: 99%

“…The criteria for indicators such as the MESS score and the fracture classification need to be carefully analyzed so that the limb salvage can be done in an effective manner and so that amputation is done in precisely selected cases. 15 , 16 …”

Section: Discussionmentioning

confidence: 99%

Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III

Neto

Canal

Alves³

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo analyze the characteristics of patients with Gustilo–Anderson Type III open tibial fractures treated at a tertiary care hospital in São Paulo between January 2013 and August 2014.MethodsThis was a cross-sectional retrospective study. The following data were gathered from the electronic medical records: age; gender; diagnosis; trauma mechanism; comorbidities; associated fractures; Gustilo and Anderson, Tscherne and AO classifications; treatment (initial and definitive); presence of compartment syndrome; primary and secondary amputations; MESS (Mangled Extremity Severity Score) index; mortality rate; and infection rate.Results116 patients were included: 81% with fracture type IIIA, 12% IIIB and 7% IIIC; 85% males; mean age 32.3 years; and 57% victims of motorcycle accidents. Tibial shaft fractures were significantly more prevalent (67%). Eight patients were subjected to amputation: one primary case and seven secondary cases. Types IIIC (75%) and IIIB (25%) predominated among the patients subjected to secondary amputation. The MESS index was greater than 7 in 88% of the amputees and in 5% of the limb salvage group.ConclusionThe profile of patients with open tibial fracture of Gustilo and Anderson Type III mainly involved young male individuals who were victims of motorcycle accidents. The tibial shaft was the segment most affected. Only 7% of the patients underwent amputation. Given the current controversy in the literature about amputation or salvage of severely injured lower limbs, it becomes necessary to carry out prospective studies to support clinical decisions.

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“…Few data on paediatric injuries are available. Besides some reviews of paediatric open fractures [13-16], there is one retrospective investigation focussing on the relevance of the MESS in 36 children with grade IIIB and IIIC open lower extremity fractures [17]. Fagelman et al reported a limb salvage of 28.6% in patients with a MESS ≥ 7 and 89.7% in patients with a MESS < 7, respectively [17].…”

Section: Discussionmentioning

confidence: 99%

“…Most of the available research on the MESS deals with adults, and only few data on paediatric injuries exist. Despite some reviews of paediatric open fractures indicating superior outcome in children compared to adults [13-16], there is only one retrospective study investigating the applicability of the MESS to children [17]. In the present study, besides epidemiology, diagnostics, therapeutic options and outcome of paediatric extremity arterial injuries, we investigated the prognostic value of MESS in children in order to contribute some valuable evidence to this issue.…”

Section: Introductionmentioning

confidence: 99%

Traumatic extremity arterial injury in children: Epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score

et al. 2010

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BackgroundTraumatic paediatric arterial injuries are a great challenge due to low incidence and specific characteristics of paediatric anatomy and physiology. The aim of the present study was to investigate their epidemiology, diagnostic and therapeutic options and complications. Furthermore, the prognostic value of the Mangled Extremity Severity Score (MESS) was evaluated.MethodsIn a retrospective clinical study 44 children aged 9.0 ± 3.2 years treated for traumatic extremity arterial lesions in our Level I trauma center between 1971 and 2006 were enrolled. Exclusion criteria were age > 14, venous and iatrogenic vascular injury. Demographic data, mechanism of injury, severity of arterial lesions (by Vollmar and MESS), diagnostic and therapeutic management, complications and outcome were evaluated.ResultsThe most commonly injured vessel was the femoral artery (25%) followed by the brachial artery (22.7%). The mechanism of injury was penetrating (31.8%), isolated severe blunt extremity trauma (29.6%), multiple trauma (25%) and humeral supracondylar fractures (13.6%). In 63.6% no specific vascular diagnostic procedure was performed in favour of emergency surgery. Surgical reconstructive strategies were preferred (68.2%). A MESS < 7 was associated with initial (p < 0.05) and definite limb salvage (p < 0.001) of the lower extremity.ConclusionsTraumatic paediatric vascular injuries are very rare. The most common situations of vascular lesions in childhood were penetrating injuries and fractures of the extremities either as isolated injuries or in multiply injured patients. In paediatric patients, the MESS could serve as a basis for decision making for limb salvage or amputation.

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Untitled

Cited by 12 publications

References 21 publications

Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system

Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system

Analysis of the characteristics of patients with open tibial fractures of Gustilo and Anderson type III

Traumatic extremity arterial injury in children: Epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score

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