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Mangled Extremity

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Ability of lower-extremity injury severity scores to predict functional outcome after limb salvage.
Ly TV, Travison TG, Castillo RC, Bosse MJ, MacKenzie EJ; LEAP Study Group.
J Bone Joint Surg Am. 2008 Aug;90(8):1738-43.

Rationale for inclusion: This multi-center prospective study confirmed the inability of multiple scoring systems including the Mangled Extremity Severity Score, Limb Salvage Index, Predictive Salvage Index, and Hannover Fracture Scale-98 to accurately predict functional recovery after limb salvage following severe extremity trauma.   

Citations - 98 (as of July 2017)

A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores.
Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, Sanders RW, Jones AL, McAndrew MP, Patterson BM, McCarthy ML, Cyril JK.
J Bone Joint Surg Am. 2001 Jan;83-A(1):3-14.

Rationale for inclusion: This prospective study challenged the ability of the Mangled Extremity Severity Score (MESS) to accurately predict need for primary amputation.  Using 556 high energy lower-extremity injuries, MESS accurately predicted limb salvage when low, but was not sensitive to predict amputation rate when high and concluded the MESS should be used with caution.

Citations - 314 (as of July 2017)

Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.
Helfet DL, Howey T, Sanders R, Johansen K.
Clin Orthop Relat Res. 1990 Jul;(256):80-6.

Rationale for inclusion: Using the Mangled Extremity Severity Score complied of readily accessible data regarding skeletal/soft-tissue damage, ischemia, shock, and age, need for primary amputation was accurately predicted in a prospective fashion in 26 lower-extremity open fractures.  MESS>7 was 100% predictable for amputation.

Citations - 395 (as of July 2017)

Objective criteria accurately predict amputation following lower extremity trauma.
Johansen K, Daines M, Howey T, Helfet D, Hansen ST Jr.
J Trauma. 1990 May;30(5):568-72; discussion 572-3.

Rationale for inclusion: This study reviewed objective data confirming the use of the Mangled Extremity Severity Score, compiling skeletal/soft-tissue damage, ischemia, shock, and age, as a valid tool to predict need for limb amputation after devastating extremity trauma.  

Citations - 623 (as of July 2017)

The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity.
Gregory RT, Gould RJ, Peclet M, Wagner JS, Gilbert DA, Wheeler JR, Snyder SO, Gayle RG, Schwab CW.
J Trauma. 1985 Dec;25(12):1147-50.

Rationale for inclusion: This series is one of the firs t to identify and define a grading system to characterize the Mangled Extremity Syndrome in order to identify the potential for limb salvage versus need for likely amputation.

 Citations - 276 (as of July 2017)

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