Limb salvage results of Gustilo IIIC fractures of the lower extremity.

This study aims to present our results for limb salvage in Gustilo IIIC open fractures of the femur and tibia. 92 patients with Gustilo IIIC fractures operated in our clinic between January 2000 and March 2016 were retrospectively evaluated. Demographic data, ischemia time, method of arterial repair, means of primary and secondary fixation, time to amputation, complications, and final VAS scores were recorded. The difference between the primary amputation rates of tibia and femur fractures was not statisti- cally significant (18% vs 21%, p>0.05). The difference between the secondary amputation rates of tibia and femur fractures was not significant (16% vs 27%, p>0.05). All secondary amputations were done within the first month during the initial hospital stay. Overall limb salvage rate was 69% for Gustilo IIIC fractures of the femur and 58% for Gustilo IIIC fractures of the tibia. The overall limb salvage rate was not significantly different between the two groups (p>0.05). At the final follow-up, patients in the limb salvage group had average VAS scores of 4.3 (femur) and 4.7 (tibia). The decision between amputation versus limb salvage remains a difficult decision that should be jointly made by the treating physicians and the patient.

[1]  O. Barbier,et al.  Comments on: "Is amputation a viable treatment option in lower extremity trauma?" of M Barla, B Gavanier, M Mangin, J Parot, C Bauer, D Mainard published in Orthop Traumatol Surg Res 2017;103(6):971-975. , 2017, Orthopaedics & traumatology, surgery & research : OTSR.

[2]  H. Balci,et al.  Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up , 2017, European Journal of Trauma and Emergency Surgery.

[3]  S. Hajdu,et al.  Third degree open fractures and traumatic sub-/total amputations of the upper extremity: Outcome and relevance of the Mangled Extremity Severity Score. , 2016, Orthopaedics & traumatology, surgery & research : OTSR.

[4]  A. Piccioli,et al.  Primary amputation vs limb salvage in mangled extremity: a systematic review of the current scoring system , 2015, BMC Musculoskeletal Disorders.

[5]  R. Jayakumar,et al.  Total and subtotal amputation of lower limbs treated by acute shortening, revascularization and early limb lengthening with ilizarov ring fixation - a retrospective study. , 2015, Injury.

[6]  E. Cansu,et al.  Functional Results of Limb Salvage in Below-Knee Type III C Open Fractures or Traumatic Amputations , 2012, Journal of Reconstructive Microsurgery.

[7]  P. Giannoudis,et al.  Gustilo IIIC fractures in the lower limb: our 15-year experience. , 2012, The Journal of bone and joint surgery. British volume.

[8]  T. Higgins,et al.  Lower Extremity Assessment Project (LEAP)--the best available evidence on limb-threatening lower extremity trauma. , 2010, The Orthopedic clinics of North America.

[9]  Melissa L McCarthy,et al.  The insensate foot following severe lower extremity trauma: an indication for amputation? , 2005, The Journal of bone and joint surgery. American volume.

[10]  R. Gustilo,et al.  OTD classic article review - Gustillo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses , 2002, The Journal of bone and joint surgery. American volume.

[11]  M F Swiontkowski,et al.  A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores , 2001, The Journal of bone and joint surgery. American volume.

[12]  D. N. Williams,et al.  Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. , 1984, The Journal of trauma.