Clinical Assessment and Factors Influencing Treatment Strategy and Outcomes in Complex Limb Injuries

Complex limb injuries are high-energy injuries that may threaten limb viability and confer significant morbidity and mortality. Prompt clinical assessment and decision-making are critical to determining the optimal management strategy, i.e., limb salvation or amputation. A clinical assessment based on advanced trauma life support (ATLS) principles is conducted to identify injuries that threaten life or limb. Patients' physiological status is evaluated using validated scoring tools, such as the injury severity score, to identify high-risk individuals who may need treatment following damage control orthopedic principles. Clinicians must assume a high degree of suspicion of vascular injury and may reliably use CT angiography to detect clinically relevant vascular injuries. Several clinical tools have been developed to help decide between primary amputation or salvation of mangled limbs; however, none have proven valid as sole indicators. Decision-making must involve the consideration of a multitude of injury- and patient-related variables in addition to clinical scoring systems. This review provides an outline of the clinical assessment and factors influencing treatment strategy and outcomes in complex limb injuries based on current evidence.