mangled_extremity_score

Mangled Extremity Severity Score (MESS)

- from Johansen et.al. 1990) Skeletal / soft-tissue injury     Low energy (stab; simple fracture; pistol gunshot wound)            1      Medium energy (open or multiple fractures, dislocation)              2      High energy (high speed MVA or rifle GSW)                               3      Very high energy (high speed trauma + gross contamination)      4 Limb ischemia      Pulse reduced or absent but perfusion normal                            1*      Pulseless; paresthesias, diminished capillary refill                      2      Cool, paralyzed, insensate, numb                                              3* Shock      Systolic BP always > 90 mm Hg                                               0      Hypotensive transiently                                                             1      Persistent hypotension                                                             2 Age (years)      < 30                                                                                        0 30-50                                                                                      1      > 50                                                                                        2


 * Score doubled for ischemia > 6 hours

- Discussion: - in the report by Bosse et al (JBJS 2001), the authors studied the clinical utility of five lower extremity injury-severity scoring systems; - 546 high-energy lower-extremity injuries were prospectively evaluated with use of five injury-severity scoring systems for lower-extremity trauma designed to assist in the decision-making process for the care of patients with such injuries; - 407 limbs remained in the salvage pathway six months after the injury; - the analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores; - high specificity of the scores in all of the patient subgroups did confirm that low scores could be used to predict limb-salvage potential; - the converse was not true - low sensitivity of the indices failed to support the validity of the scores as predictors of amputation. - see tibial defect reconstruction and amputation following tibia fractures

http://www.wheelessonline.com/ortho/mangled_extremity_severity_score_mess

Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.

http://www.wheelessonline.com/ortho/limb_salvage_versus_amputation_preliminary_results_of_the_mangled

A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores Michael J. Bosse, MD et al. (J Bone Joint Surg [Am] 83-A: 3-14, 2001) http://www.wheelessonline.com/ortho/limb_salvage_versus_amputation_preliminary_results_of_the_mangled

To Reconstruct or Not to Reconstruct? http://content.nejm.org/cgi/content/full/347/24/1906

An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.