Physical Disability After Severe Lower-Extremity Injury (original) (raw)
A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores
The Journal of Bone and Joint Surgery American Volume, 2001
Permissions] link. and click on the [Reprints and jbjs.org article, or locate the article citation on to use material from this order reprints or request permission Click here to Background: High-energy trauma to the lower extremity presents challenges with regard to reconstruction and rehabilitation. Failed efforts at limb salvage are associated with increased patient mortality and high hospital costs. Lower-extremity injury-severity scoring systems were developed to assist the surgical team with the initial decision to amputate or salvage a limb. The purpose of the present study was to prospectively evaluate the clinical utility of five lower-extremity injury-severity scoring systems. Methods: Five hundred and fifty-six 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. Four hundred and seven limbs remained in the salvage pathway six months after the injury. The sensitivity, specificity, and area under the receiver operating characteristic curve were calculated for the Mangled Extremity Severity Score (MESS); the Limb Salvage Index (LSI); the Predictive Salvage Index (PSI); the Nerve Injury, Ischemia, Soft-Tissue Injury, Skeletal Injury, Shock, and Age of Patient Score (NISSSA); and the Hannover Fracture Scale-97 (HFS-97) for ischemic and nonischemic limbs. The scores were analyzed in two ways: including and excluding limbs that required immediate amputation. Results: The analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores. The 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, however, was not true. The low sensitivity of the indices failed to support the validity of the scores as predictors of amputation. Conclusions: Lower-extremity injury-severity scores at or above the amputation threshold should be cautiously used by a surgeon who must decide the fate of a lower extremity with a high-energy injury.
What Factors Are Associated With Disability After Upper Extremity Injuries? A Systematic Review
Clinical orthopaedics and related research, 2018
Psychosocial factors are key determinants of health after upper extremity injuries. However, a systematic review is needed to understand which psychosocial factors are most consistently associated with disability and how the language, conceptualization, and types of measures used to assess disability impact these associations in upper extremity injuries. (1) What factors are most consistently associated with disability after upper extremity injuries in adults? (2) What are the trends in types of outcome measures and conceptualization of disability in patients' upper extremity injuries? We searched multiple electronic databases (PubMED, OVIDSP, PsycInfo, Google Scholar, ISI Web of Science) between January 1, 1996, and December 31, 2016, using terms related to the "upper extremity", "outcome measurement", and "impairment, psychological, social or symptomatic" variables. We included all studies involving adult patients with any musculoskeletal injury a...
Indian Journal of Plastic Surgery, 2019
An open fracture with extensive skin and soft tissue loss is considered as a severely injured lower extremity. Advances in rapid transport, resuscitation, skeletal fixation, and microsurgical techniques to cover large soft tissue and bone defects have made possible the salvage of these severely injured limbs. Salvage exercise is skill and resource intensive and could take a long time frame. The goal of management is to obtain painless independent weight bearing walking in a time frame and cost that the patient can afford.Decisions taken and the quality of care provided on day 1 determine the ultimate success. Inappropriate decisions and treatment lead to increased morbidity and secondary amputation. Infection is the commonest complication. Limb salvage scores are helpful to predict salvage and guide the sequence of treatment. Once the decision is taken for salvage, debridement, early skeletal fixation, and soft tissue cover are the key to success.
Rehabilitation after lower limb injury: development of a predictive score (RALLI score)
Canadian journal of surgery. Journal canadien de chirurgie, 2015
BACKGROUND The purpose of our study was to identify the risk factors associated with the need for inpatient rehabilitation after lower limb injury to develop a predictive scoring tool for early identification of such patients. METHODS We followed a prospective cohort of patients admitted to a level 1 trauma centre. Data were collected through chart review and a self-administered questionnaire on sociodemographics, patient living environment, pretrauma status, injury and treatment received. We compared patients who were discharged home with those going to rehabilitation after acute care. Analysis consisted of bivariate comparisons and logistic regression. RESULTS Our study included 160 patients with a mean age of 56 years. A total of 40% were discharged to an inpatient rehabilitation centre. Factors associated with inpatient rehabilitation were low preinjury physical health status, concomitant injury of the upper limbs, bilateral lower limb injury, the use of a walking aid before inj...
Functional Outcomes Following Trauma-Related Lower-Extremity Amputation
The Journal of Bone and Joint Surgery-American Volume, 2004
Background: The principal aims of this study were to examine functional outcomes following trauma-related lowerextremity amputation and to compare outcomes according to the amputation levels. We hypothesized that above-theknee amputations would result in less favorable outcomes than would through-the-knee or below-the-knee amputations. A secondary aim was to examine the factors, in addition to amputation level, that influence outcome, including the type of soft-tissue coverage, selected patient characteristics, and the technological sophistication of the prosthetic device. Methods: A cohort of 161 patients who had undergone an above-the-ankle amputation at a trauma center within three months following the injury was followed prospectively at three, six, twelve, and twenty-four months after the injury. The Sickness Impact Profile, a self-reported measure of functional status, was used as the principal measure of outcome. Secondary outcomes included pain; degree of independence in transfers, walking, and climbing stairs; selfselected walking speed; and the physician's satisfaction with the clinical, functional, and cosmetic recovery of the limb. Longitudinal multivariate regression techniques were used to determine whether outcomes differed according to the level of amputation after we controlled for covariates. Results: There was no significant difference in the scores on the Sickness Impact Profile between the patients treated with above-the-knee and those treated with below-the-knee amputation. However, patients with a below-theknee amputation performed better than did patients with an above-the-knee amputation on the timed test for walking speed (p = 0.04). Patients with a through-the-knee amputation had worse regression-adjusted Sickness Impact Profile scores (p = 0.05) and slower self-selected walking speeds (p = 0.004) than did patients with either a below-theknee or an above-the-knee amputation. Differences according to the level of amputation were most pronounced for physical function. In general, physicians were less satisfied with the clinical, cosmetic, and functional recovery of the patients with a through-the-knee amputation. Except for problems encountered with insufficient gastrocnemius coverage of the stump in many patients with a through-the-knee amputation, neither the soft-tissue coverage nor the technological sophistication of the prosthesis correlated with outcome. Conclusions: Severe disability accompanies above-the-ankle lower-extremity amputation following trauma, regardless of the level of amputation. Clinicians should critically evaluate the need for a through-the-knee amputation in patients with a traumatic injury. The results of this study also underscore the need for controlled studies that examine the relationship between the type and fit of prosthetic devices and functional outcomes.
Journal of Pain and Relief, 2022
The aim of this article is to highlight the importance of interventions for successful recovery from an injury sustained in the lower kinetic chain. The article is intended to give a background and understanding to the general population, working professionals, athletes, military personnel, first responders or anyone that has experienced pain and discomfort from a lower extremity injury about the biomechanical intricacies of the lower extremity and how injury affects each component. The kinetic chain is a musculoskeletal biomechanical theory on how the lower extremity moves within itself to produce movement such as walking, running, standing and sitting. Within these movements, each component of the kinetic chain has an effect on each component which surrounds the joint. When injury occurs in the musculoskeletal system there is a cumulative injury cycle effect throughout the kinetic chain. The cumulative cycle affects the skeletal, muscular, and articular systems and will impair move In summary, the cumulative injury cycle can impede function and lower kinetic chain performance. During and after an injury, it is important to remain active and mobile as much as possible. Interventions such as osteopathic/myofacial manual therapy treatment and corrective exercises are good modalities to use to help alleviate pain (both chronic and acute), but also to reduce the effects of the lower extremity kinetic chain from becoming stuck in the inflammatory or proliferative phase of healing. Being stuck in one of the 2 phases of the injury cycle contributes to the cumulative injury of the area that is being injured and causes prolonged recovery. In addition, stretching and self-myofacial release (SMR) can benefit a person in maintaining flexibility within the human movement system. A duration of as little as 10 minutes devoted to SMR (up to a minute on each extremity, the back and chest) can increase flexibility, decrease accumulation of adhesions formed on muscle fibers and prevent stiffness and changes in muscle fiber (degenerative changes) caused from sedentary lifestyle. Both OMT/MMR and corrective exercise treatment are underutilized in majority of outpatient clinics and therefore needs to be strongly emphasized for all practitioners to learn, especially if the goal of the practitioner is to decrease pain/discomfort and to increase functional mobility within their patient populations. Mobility and proper conditioning of the musculoskeletal system equates kinetic chain functionality and good health throughout the extremity in the lower extremity. Treatment modalities need to focus on the specific area of injury. The modalities can be in the form of stretching, manual osteopathic treatment (OMT)/ Manual myofacial release (MMR), therapeutic/corrective exercise programming. Research supports eccentric exercises effectiveness in helping retrain the body back into conditioning for sports or everyday -functionality. These treatment modalities have the greatest effect on correcting and stopping the cumulative injury cycle in the lower kinetic chain.