|
The Journal of Bone and Joint Surgery, Vol 75, Issue 10 1431-1441, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation
GM Georgiadis, FF Behrens, MJ Joyce, AS Earle and AL Simmons
Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio 44109-1998.
The long-term outcomes and the quality of life were studied in patients who
had had an open fracture of the tibial shaft with severe soft-tissue loss.
Limb salvage with a free flap was attempted in twenty-seven patients
(sixteen of whom had a successful procedure and were examined personally by
us), while eighteen patients were managed concurrently with an early
below-the-knee amputation. Soft-tissue coverage was successful in all but
one patient in whom limb salvage had been attempted. Ultimately, however,
five extremities were amputated, with an infection at the site of a
non-union being the most common reason for amputation. The patients who had
had limb salvage had more complications (p < 0.001), more operative
procedures (p < 0.001), and a longer stay in the hospital (p < 0.05)
than the patients who had had an early below-the-knee amputation. The
long-term functional results for sixteen patients who had had a successful
limb-salvage procedure (average duration of follow-up, thirty-five months)
were compared with those for eighteen patients who had had a below-the-knee
amputation (average duration of follow-up, forty-four months). The patients
who had had a successful limb-salvage procedure took significantly more
time to achieve full weight-bearing (p < 0.05), were less willing or
able to work (p < 0.01), and had higher hospital charges (p < 0.006)
than the patients who had been managed with an early below-the-knee
amputation. They also had a significant decrease in motion at the ankle and
subtalar joint in the injured leg compared with the contralateral leg (p
< 0.001). A quality-of-life evaluation was possible for only thirteen of
the patients who had had a successful limb-salvage procedure and for
sixteen of the patients who had had a below-the-knee amputation. The two
groups were similar in terms of their responses, but significantly more
patients who had had limb salvage considered themselves severely disabled
(p < 0.05). They also had more problems with the performance of
occupational and recreational activities (p < 0.05). This study
confirmed the reliability of modern microvascular free tissue techniques
for the coverage of large soft-tissue defects associated with tibial
fractures. It also showed that complications and difficulties in the
restoration of osseous union are common and may be directly related to the
less satisfactory functional, occupational, recreational, and
quality-of-life outcomes that are seen in many patients who have had limb
salvage.(ABSTRACT TRUNCATED AT 400 WORDS)
 CiteULike  Connotea  Del.icio.us  Technorati What's this?
This article has been cited by other articles:
|
|
|
|
 
E. J. Sella
Review: Prevention and Management of Complications of the Ilizarov Treatment Method
Foot & Ankle Specialist,
April 1, 2008;
1(2):
105 - 107.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. J. Morgan, J. Newman, K. Ozer, W. Smith, and R. Gurunluoglu
Salvage of a Below-the-Knee Amputation Level Following a Type-IIIB Open Tibial Fracture. A Case Report
J. Bone Joint Surg. Am.,
December 1, 2007;
89(12):
2769 - 2778.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. J. MacKenzie, R. C. Castillo, A. S. Jones, M. J. Bosse, J. F. Kellam, A. N. Pollak, L. X. Webb, M. F. Swiontkowski, D. G. Smith, R. W. Sanders, et al.
Health-Care Costs Associated with Amputation or Reconstruction of a Limb-Threatening Injury
J. Bone Joint Surg. Am.,
August 1, 2007;
89(8):
1685 - 1692.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. R Archer, R. C Castillo, E. J MacKenzie, M. J Bosse, and and the Lower Extremity Assessment Project (LEAP)
Gait Symmetry and Walking Speed Analysis Following Lower-Extremity Trauma
Physical Therapy,
December 1, 2006;
86(12):
1630 - 1640.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. V. Giannoudis, C. Papakostidis, and C. Roberts
A review of the management of open fractures of the tibia and femur
J Bone Joint Surg Br,
March 1, 2006;
88-B(3):
281 - 289.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. J. MacKenzie, M. J. Bosse, A. N. Pollak, L. X. Webb, M. F. Swiontkowski, J. F. Kellam, D. G. Smith, R. W. Sanders, A. L. Jones, A. J. Starr, et al.
Long-Term Persistence of Disability Following Severe Lower-Limb Trauma. Results of a Seven-Year Follow-up
J. Bone Joint Surg. Am.,
August 1, 2005;
87(8):
1801 - 1809.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. S. Roberts, H.-C. Pape, A. L. Jones, A. L. Malkani, J. L. Rodriguez, and P. V. Giannoudis
Damage Control Orthopaedics. Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic Trauma
J. Bone Joint Surg. Am.,
February 1, 2005;
87(2):
434 - 449.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Bhandari
Should severely injured legs be saved or amputated?
Can. Med. Assoc. J.,
June 10, 2003;
168(12):
1570 - 1570.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Bosse, E. J. MacKenzie, J. F. Kellam, A. R. Burgess, L. X. Webb, M. F. Swiontkowski, R. W. Sanders, A. L. Jones, M. P. McAndrew, B. M. Patterson, et al.
An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries
N. Engl. J. Med.,
December 12, 2002;
347(24):
1924 - 1931.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
