Firearm-Related Lower Extremity Injuries: Treatment Approaches and MESS Score Usability

To evaluate isolated firearm-related lower extremity injury (LEI) treated according to the current treatment of damage control orthopaedics (DCO) or traditional early comprehensive treatment (TECT), and to validate the usability of Mangled Extremity Severity Score (MESS).

Observational study. Place and Duration of the Study: Department of Orthopaedic Surgery, Diyarbakir Gazi Yasargil Training and Research Hospital, Turkiye, from November 2017 to November 2022.

A total of 93 adult patients with isolated firearm-induced LEI requiring surgical intervention for open bone fractures at a level I trauma centre were included. The study assessed the severity of LEI using MESS based on the patients' medical records.

DCO technique was used for 54.8% (51) of patients. There were statistically significant differences in terms of amputations and limb salvage between the DCO and TECT groups (χ2:6,234, p<0.05). The mean MESS was 8.9 ± 0.7 in all fatalities, 6.3 ± 1.1 in limb amputations, and 3.8 ± 1.5 in salvaged limbs. Moreover, the DCO and TECT groups showed statistically significant differences regarding postoperative non-union (χ2:3,720, p<0.05), with DCO groups experiencing a higher rate of non-union (18.2%) as compared to TECT groups [7.1%, Exp (B):3.77].

In isolated LEI caused by firearms, MESS could predict outcomes (i.e. mortality, amputation, or limb salvage) and assist in the choice between DCO or TECT techniques. DCO was preferred by orthopaedic surgeons when treating severe LEI caused by firearms.

Mangled Extremity Severity Score, Firearm, Damage control orthopaedics, Early comprehensive treatment.