حفظيا قطع اندام هاي شديدا آسيب ديده ، مشكل ترين تصميم در جراحي ارتوپدي

Decision making for leg amputation with a scoring system

The decision to salvage or amputate a severely injured limb is one of the most difficult an orthopaedic surgeon many face. Such a decision is rarely clear-cut. In this study we present 36 cases of severely injured limb with arterial damage. In our cases we evaluated the efficacy of limb injury scoring system like MESS, MESI, NISSSA, and PSI scoring system in predicting results of limb saving surgery. Eight (24.2%) of the limbs were amputated; seven (88%) amputations were lower extremity, and one (12%) was upper extremity. The MESS, NISSSA demonstrated a high specificity (88%, 80% respectively) and high sensitivity (87% each) but other scoring systems had lower values. The relative importance of each of the associated trauma parameters is still of questionable predictive value. We proposed a new Combined Salvage Scoring System.