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Predicting the need for early amputation in ballistic mangled extremity injuries.

Kate V Brown1, A Ramasamy, J McLeod

  • 1Academic Department of Military Surgery and Trauma, Royal College of Defence Medicine, Birmingham, United Kingdom. katevbrown@aol.com

The Journal of Trauma
|April 11, 2009
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The Mangled Extremity Severity Score (MESS) is not reliable for deciding on lower extremity amputations in military patients with ballistic injuries. Early amputation is crucial for these specific injuries.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Surgery
  • Military Medicine

Background:

  • Amputation remains a common surgical procedure in warfare, particularly for lower extremity high-energy trauma.
  • Existing amputation scoring systems, like the Mangled Extremity Severity Score (MESS), were developed on civilian populations and have inconclusive evidence for military use.
  • The validity of the MESS in military patients with ballistic extremity injuries requires assessment.

Purpose of the Study:

  • To assess the validity of the Mangled Extremity Severity Score (MESS) in UK military patients with ballistic mangled extremity injuries.
  • To determine if the MESS can reliably guide amputation decisions in this specific patient population.

Main Methods:

  • Retrospective evaluation of 77 military patients (86 limbs) with ballistic lower limb open fractures from the Joint Theater Trauma Registry (May 2003-April 2008).
  • Patients were assessed using the MESS for lower extremity trauma.
  • Comparison between patients who required amputation and those who underwent successful limb salvage.

Main Results:

  • The MESS did not effectively determine the appropriateness of amputation for ballistic extremity injuries.
  • Patient age was not a relevant factor in amputation decisions.
  • A skeletal score of 4 on the MESS was associated with a higher amputation rate but did not predict the need for amputation.
  • Amputations were frequently performed due to limb ischemia and the patient's overall condition precluding extensive reconstruction.

Conclusions:

  • Management of ballistic extremity injuries in military personnel should be distinct from civilian high-energy trauma.
  • Early amputation is a critical factor in managing military mangled extremities.
  • The MESS is not a reliable tool for guiding amputation decisions in this cohort.