Predictive Outcome Score in Lower Limb Reconstructive Surgery. Preliminary Test
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Published:
Dec 16, 2021
Keywords:
Tibia, Ilizarov, post-traumatic sequelae.
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Abstract
Introduction: Post-traumatic sequelae in the limbs are a very difficult condition to approach due to the severity of the injuries and the lack of treatment protocols, which considerably hinder the choice of the best treatment alternative. The objective of this study was to analyze the outcomes of reconstructive treatment with a pre-surgical score designed ad-hoc and to evaluate its predictability.
Materials and Methods: A retrospective cohort-type analysis of the outcomes of external fixation treatment was performed in 32 patients with traumatic leg sequelae in the last 7 years who were staged with a pre-operative score designed ad-hoc. This was compared with the results obtained with the ASAMI score with a minimum 2-year follow-up.
Results: We obtained a direct relationship between pre-surgical staging and the final outcome. This relationship is reflected by obtaining a high percentage of excellent outcomes in low-risk patients (50%) and 60% of poor outcomes in high-risk patients.
Conclusions: The current evidence is contradictory and there is controversy over which is the best treatment option. We found that high-risk patients have a high percentage of poor outcomes and may not benefit from reconstructive surgery.
Materials and Methods: A retrospective cohort-type analysis of the outcomes of external fixation treatment was performed in 32 patients with traumatic leg sequelae in the last 7 years who were staged with a pre-operative score designed ad-hoc. This was compared with the results obtained with the ASAMI score with a minimum 2-year follow-up.
Results: We obtained a direct relationship between pre-surgical staging and the final outcome. This relationship is reflected by obtaining a high percentage of excellent outcomes in low-risk patients (50%) and 60% of poor outcomes in high-risk patients.
Conclusions: The current evidence is contradictory and there is controversy over which is the best treatment option. We found that high-risk patients have a high percentage of poor outcomes and may not benefit from reconstructive surgery.
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How to Cite
Vivas, M. R. (2021). Predictive Outcome Score in Lower Limb Reconstructive Surgery. Preliminary Test. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(6), 771-779. https://doi.org/10.15417/issn.1852-7434.2021.86.6.1140
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Clinical Research
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References
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https://iris.paho.org/handle/10665.2/31080
2. Shanmuganathan R. The utility of scores in the decision to salvage or amputation in severely injured limbs. Indian J Orthop 2008;42(4):368-76. https://doi.org/10.4103/0019-5413.43371
3. Russell WL, Sailors DM, Whittle TB, Fisher DF Jr, Burns RP. Limb salvage versus traumatic amputation. A
decision based on a seven-part predictive index. Ann Surg 1991;213:473-81. https://doi.org/10.1097/00000658-199105000-00013
4. McCarthy JJ, Iobst CA, Rozbruch SR, Sabharwal S, Eismann EA. Limb Lengthening and Reconstruction Society
AIM index reliably assesses lower limb deformity. Clin Orthop Relat Res 2013;471(2):621-7.
https://doi.org/10.1007/s11999-012-2609-8
5. Vivas MR, Cordano OR. Utilización del método Ilizarov para el tratamiento de desejes y discrepancias
postraumáticos de la tibia. Serie de casos. Rev Asoc Argent Ortop Traumatol 2019;84(2):136-42.
https://doi.org/10.15417/issn.1852-7434.2019.84.2.827
6. Harris AM, Althausen PL, Kellam J, Bosse MJ, Castillo R; Lower Extremity Assessment Project (LEAP) Study
Group. Complications following limb-threatening lower extremity trauma. J Orthop Trauma 2009;23(1):1-6.
https://doi.org/10.1097/BOT.0b013e31818e43dd
7. Howe H Jr, Poole G, Hansen K, Clark T, Plonk G, Koman L, et al. Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg 1987;53:205-8. PMID: 3579025
8. Johansen K, Daines M, Howey T, Helfet D, Hansen ST Jr. Objective criteria accurately predict amputation
following lower extremity trauma. J Trauma 1990;30:568-73. https://doi.org/10.1097/00005373-199005000-00007
9. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of
reconstruction or amputation after leg-threatening injuries. N Engl J Med 2002;347(24):1924-31.
https://doi.org/10.1056/NEJMoa012604
10. MacKenzie EJ, Bosse MJ, Pollak AN, Webb LX, Swiontkowski MF, Kellam JF, et al. Long-term persistence
of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am
2005;87(8):1801-9. https://doi.org/10.2106/JBJS.E.00032
11. McNamara MG, Heckman JD, Corley EG. Severe open fracture of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score. J Orthop Trauma 1994;8:81-7. https://doi.org/10.1097/00005131-199404000-00001
12. Tonon da Luz SC, Avila AOV, Olivera TP, Andrade MC, Ventoza Lacunza C. Valoración del daño corporal en
amputados de miembros inferiores: prueba de sensibilidad, postura, sobrecarga articular y calidad de vida. Trauma 2010;21(3):178-83. Disponible en: https://app.mapfre.com/fundacion/html/revistas/trauma/v21n3/pdf/02_08.pdf
13. Samitier CB, Guirao L, Pleguezuelos E, Perez Mesquida ME. Valoración de la movilidad en pacientes con
amputación de miembro inferior. Rehabilitación 2011;45(1):61-6. https://doi.org/10.1016/j.rh.2010.09.006
14. Cirpar M, Cetik O, Uslu M, Eksioglu F. Common complications of segmental bone transport with Ilizarov technique in defective tibia pseudoarthrosis: a review. Eur J Orthop Surg Traumatol 2006;16:380-5.
https://doi.org/10.1007/s00590-006-0089-9
15. Kawoosa AA, Majid S, Halwai MA, Mohd Mir MR, Mir GR. Femoral lengthening by Ilizarov technique. Results
and complications. JK Science 2004;6(3):163. Disponible en: http://jkscience.org/archive/volume63/femoral.pdf
16. Capomassi A, Oliveto R, D´Elia M, Oliveto A, Lombardo E. Pseudoartrosis con pérdida ósea de fémur y de tibia.
Rev Asoc Argent Ortop Traumatol 2005;70(1):45-52. Disponible en:
https://aaot.org.ar/wp-content/uploads/2021/10/Rev-Asoc-Argent-Ortop-Traumatol-2005-70-1-45 52_Capomassi.pdf
17. Puerta-Gómez A, Lugo-Agudelo LH, Castaño-González A, Posada-Borrero AM. Reconstrucción versus amputación en pacientes con lesiones graves del miembro inferior. Recomendaciones basadas en la evidencia para la Guía de Práctica Clínica de personas amputadas de miembro inferior en Colombia. Iatreia 2006;29(Suppl 4):S72-S81. Disponible en: http://hdl.handle.net/10495/12633
https://iris.paho.org/handle/10665.2/31080
2. Shanmuganathan R. The utility of scores in the decision to salvage or amputation in severely injured limbs. Indian J Orthop 2008;42(4):368-76. https://doi.org/10.4103/0019-5413.43371
3. Russell WL, Sailors DM, Whittle TB, Fisher DF Jr, Burns RP. Limb salvage versus traumatic amputation. A
decision based on a seven-part predictive index. Ann Surg 1991;213:473-81. https://doi.org/10.1097/00000658-199105000-00013
4. McCarthy JJ, Iobst CA, Rozbruch SR, Sabharwal S, Eismann EA. Limb Lengthening and Reconstruction Society
AIM index reliably assesses lower limb deformity. Clin Orthop Relat Res 2013;471(2):621-7.
https://doi.org/10.1007/s11999-012-2609-8
5. Vivas MR, Cordano OR. Utilización del método Ilizarov para el tratamiento de desejes y discrepancias
postraumáticos de la tibia. Serie de casos. Rev Asoc Argent Ortop Traumatol 2019;84(2):136-42.
https://doi.org/10.15417/issn.1852-7434.2019.84.2.827
6. Harris AM, Althausen PL, Kellam J, Bosse MJ, Castillo R; Lower Extremity Assessment Project (LEAP) Study
Group. Complications following limb-threatening lower extremity trauma. J Orthop Trauma 2009;23(1):1-6.
https://doi.org/10.1097/BOT.0b013e31818e43dd
7. Howe H Jr, Poole G, Hansen K, Clark T, Plonk G, Koman L, et al. Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg 1987;53:205-8. PMID: 3579025
8. Johansen K, Daines M, Howey T, Helfet D, Hansen ST Jr. Objective criteria accurately predict amputation
following lower extremity trauma. J Trauma 1990;30:568-73. https://doi.org/10.1097/00005373-199005000-00007
9. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of
reconstruction or amputation after leg-threatening injuries. N Engl J Med 2002;347(24):1924-31.
https://doi.org/10.1056/NEJMoa012604
10. MacKenzie EJ, Bosse MJ, Pollak AN, Webb LX, Swiontkowski MF, Kellam JF, et al. Long-term persistence
of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am
2005;87(8):1801-9. https://doi.org/10.2106/JBJS.E.00032
11. McNamara MG, Heckman JD, Corley EG. Severe open fracture of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score. J Orthop Trauma 1994;8:81-7. https://doi.org/10.1097/00005131-199404000-00001
12. Tonon da Luz SC, Avila AOV, Olivera TP, Andrade MC, Ventoza Lacunza C. Valoración del daño corporal en
amputados de miembros inferiores: prueba de sensibilidad, postura, sobrecarga articular y calidad de vida. Trauma 2010;21(3):178-83. Disponible en: https://app.mapfre.com/fundacion/html/revistas/trauma/v21n3/pdf/02_08.pdf
13. Samitier CB, Guirao L, Pleguezuelos E, Perez Mesquida ME. Valoración de la movilidad en pacientes con
amputación de miembro inferior. Rehabilitación 2011;45(1):61-6. https://doi.org/10.1016/j.rh.2010.09.006
14. Cirpar M, Cetik O, Uslu M, Eksioglu F. Common complications of segmental bone transport with Ilizarov technique in defective tibia pseudoarthrosis: a review. Eur J Orthop Surg Traumatol 2006;16:380-5.
https://doi.org/10.1007/s00590-006-0089-9
15. Kawoosa AA, Majid S, Halwai MA, Mohd Mir MR, Mir GR. Femoral lengthening by Ilizarov technique. Results
and complications. JK Science 2004;6(3):163. Disponible en: http://jkscience.org/archive/volume63/femoral.pdf
16. Capomassi A, Oliveto R, D´Elia M, Oliveto A, Lombardo E. Pseudoartrosis con pérdida ósea de fémur y de tibia.
Rev Asoc Argent Ortop Traumatol 2005;70(1):45-52. Disponible en:
https://aaot.org.ar/wp-content/uploads/2021/10/Rev-Asoc-Argent-Ortop-Traumatol-2005-70-1-45 52_Capomassi.pdf
17. Puerta-Gómez A, Lugo-Agudelo LH, Castaño-González A, Posada-Borrero AM. Reconstrucción versus amputación en pacientes con lesiones graves del miembro inferior. Recomendaciones basadas en la evidencia para la Guía de Práctica Clínica de personas amputadas de miembro inferior en Colombia. Iatreia 2006;29(Suppl 4):S72-S81. Disponible en: http://hdl.handle.net/10495/12633