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Functional outcome of bilateral limb threatening: lower extremity injuries at two years postinjury
Joel J Smith1, Julie Agel, Marc F Swiontkowski
1Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.
Objectives:
To describe the functional outcome of bilateral limb-threatening injuries at 2 years postinjury and to evaluate whether a different decision-making process should be used for these patients as opposed to patients with unilateral limb-threatening injury.
Design/Setting/Patients:
This study population of 32 patients is a subset of 601 patients from a study of 8 level I trauma centers. The patients were prospectively followed through 24 months.
Main Outcome Measurements:
The principle outcome measure at 2 years was the Sickness Impact Profile, designed to measure physical and psychosocial dimensions.
Results:
The overall Sickness Impact Profile scores at 2 years demonstrate that all 3 bilateral injury groups (bilateral salvage [n = 14], unilateral salvage/amputation [n = 8], and bilateral amputation [n = 10]) were severely disabled (Sickness Impact Profile >10). The bilateral salvage group had the most dramatic improvement over the 24 months. The 2-year physical subscale Sickness Impact Profile data showed a similar trend. At the 2-year assessment, the bilateral amputation group was recording greater disability (Sickness Impact Profile = 16.3) compared to the bilateral salvage and unilateral amputation/salvage groups (Sickness Impact Profile = 8.5 and 12.6, respectively). The overall Psychosocial Dimension, which started off worst in the bilateral salvage group, ended up similar in all 3 groups (8 to 9). The percent of patients who returned to work was 66.7% in the unilateral salvage/amputation group versus 21.4 and 16% in the bilateral salvage and amputation groups, respectively.
Conclusions:
The results indicate that treatment judgments should be based upon the results derived from the analysis of the larger unilateral limb cohort data. Patients with severe, bilateral lower extremity injuries should be counseled that regardless of treatment combinations, the function of each limb is similar at 24 months. The unilateral amputation/salvage group had a greater probability of going back to work. This is the major identifiable benefit to undergoing salvage versus amputation.
