Re-evaluation of cutting criteria for limb amputation using the Mangled Extremity Severity Score

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Limb Reconstruction

Background:

• Decision-making for severe open extremity fractures is complex.
• Existing scoring systems like the Mangled Extremity Severity Score (MESS) lack consensus.
• There is a need for improved predictive tools for amputation in these cases.

Purpose of the Study:

• To identify predictive factors for amputation in open extremity fractures using MESS.
• To evaluate the optimal MESS cut-off value for predicting amputation.
• To refine the utility of MESS in current trauma care.

Main Methods:

• Retrospective analysis of Gustilo-Anderson type 3B or 3C open limb fractures.
• Comparison of MESS values between limb preservation and amputation groups.
• Receiver operating characteristic (ROC) curve analysis to determine optimal MESS cut-off.

Main Results:

• The mean MESS was significantly lower in the limb preservation group (5.7±1.5) compared to the amputation group (8.0±1.4).
• A MESS cut-off of ≥7 showed 83% sensitivity and 78% specificity.
• A MESS cut-off of ≥8 demonstrated higher specificity (92%) with 78% sensitivity, and a significantly higher area under the curve (p=0.020).

Conclusions:

• The Mangled Extremity Severity Score (MESS) is valuable for amputation decision-making.
• A revised MESS cut-off score of 8 is suggested to enhance predictive accuracy.
• This adjustment can facilitate more informed clinical decisions in severe limb trauma management.