Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 1990
Multicenter Study Comparative Study Clinical TrialLimb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.
Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. ⋯ Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p less than 0.01). In both the prospective and retrospective studies, a MESS score of greater than or equal to 7 had a 100% predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation.
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Clin. Orthop. Relat. Res. · Jul 1990
Immediate care of crush injuries and compartment syndromes with the split-thickness skin excision.
Prospective evaluation of the one-stage procedure in 32 patients who suffered from 37 severe friction-avulsion injuries was carried out. Most injuries (81%) were in the lower extremity. Split-thickness skin excision was used for immediate diagnosis of flap vascularity and wound coverage. ⋯ The split-thickness skin excision is effective in the establishment of debridement borders and helps in saving maximal viable flap area (49.4%). All wounds healed with no major wound complications. The split-thickness skin excision can be used immediately in the care of severe crush injuries, compartment syndromes, and open fractures as a one-stage procedure with the following advantages: (1) reliable diagnosis of flap vascularity, (2) immediate wound coverage with the possibility of drainage, (3) elimination of further debridements procedures, (4) elimination of distant skin donor wounds, and (5) less hospitalization.
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Clin. Orthop. Relat. Res. · Jul 1990
Review Case ReportsThe Judet quadricepsplasty for management of severe posttraumatic extension contracture of the knee. A report of a bilateral case and review of the literature.
Extension contracture of the knee is an increasingly recognized complication of severe femur fracture. Traditional management by Thompson quadricepsplasty may result in a variable return of knee flexion and the possibility of significant extension lag. The Judet technique of quadricepsplasty offers the advantages of a controlled, sequential release of the components limiting knee flexion and a reduced potential for iatrogenic quadriceps rupture or extension lag. Judet quadricepsplasty corrected severe bilateral extension contractures with excellent results at 17 months postoperatively in a 29-year-old man.