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Evaluation of the mangled extremity severity score in combat-related type III open tibia fracture
Andrew J Sheean1, Chad A Krueger, Matthew A Napierala
1*Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio Military Medical Center, Fort Sam Houston, TX; and †Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC.
Objectives:
The purpose of this study was to determine the extent to which the Mangled Extremity Severity Score (MESS) predicted outcomes for soldiers sustaining combat-related Gustilo-Anderson type III open tibia fractures.
Design:
Retrospective cohort study.
Setting:
Tertiary trauma center.
Patients:
Service Members with combat-related type III open tibia fractures occurring between 2003 and 2007 treated definitively in a US military medical center.
Intervention:
Amputation or limb salvage.
Main Outcome Measurements:
MESS, amputation or limb salvage.
Results:
Complete data were available for 155 patients treated for type III open tibia fractures. One hundred ten patients had salvaged limbs, and 45 patients had lower extremity amputations. The mean MESS values for amputees and patients treated with limb salvage were 5.8 and 5.3 (P = 0.057), respectively. The sensitivity and specificity of a MESS ≥7 predicting amputation was 35% and 87.8%, respectively. A MESS value of ≥7 was found to have a positive predictive value on 50%. Thirty-three percent of patients treated with amputation had an associated vascular injury versus 12.7% of patients treated with limb salvage (P < 0.0026).
Conclusions:
There was no significant difference between MESS values of amputees and those treated with limb salvage. Moreover, these data demonstrate that the MESS is neither sensitive nor accurate in predicting amputation.
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