In , we introduced the Mangled Extremity Severity Score (MESS), a grading system for the early assessment of severely injured lower extremities. We had. Mangled Extremity Severity Score (MESS). Introduction. used to predict necessity of amputation after lower extremity trauma. Variables. skeletal and soft tissue. fractures, soft tissue damage, vascular, nerve and tendon lesions. The Mangled Extremity Severity Score (MESS) is probably the most common scoring system.

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Once the general condition of the patient was stabilized, a detailed case history was recorded with particular importance to mode of injury, treatment taken if any, interval between injury and admission and associated medical or surgical illnesses if any. No patient died within the follow-up period. Badole, Department of Orthopedics and Traumatology, M. In the prospective manglef, out of six Once adequate soft tissue coverage had been obtained, patient was discharged and followed up at regular intervals of two weeks for progression of fracture healing.

The principal investigators of the study request that you use the seveity version of scoge modified score here.

Reduced pulse but normal perfusion. Color Doppler of mangled extremity was carried out whenever peripheral pulses were absent and perfusion was in doubt. Formula Addition of the assigned points; if there has been limb ischemia for more than 6 hours, the “limb ischemia” points are doubled.

Trauma Scoring Systems

In the prospective study, maximum period of follow-up was 28 months and minimum period was two months. Patients were shifted to the operation room and initial management of the mangled extremity was started severiy the form of thorough irrigation with copious normal saline, meticulous debridement, pressure bandage, antibiotics and fracture stabilization with external fixator.


The mean hospitalization for primary amputation was Vascular injuries of lower limb except the foot, including dislocations of the knee, ankle, closed tibial or femoral fractures and penetrating wounds with vascular injury noted on color Doppler or at the time of surgery.

Was there a clinical experience that inspired you to create this tool for clinicians? A retrospective evaluation of the mangled extremity severity score.

A decision based on a seven-part predictive index.

Wheeless’ Textbook of Orthopaedics

Massive lower extremity trauma, in particular open tibial fractures with associated vascular injuries, presents immediate and complex decision-making challenges srverity a limb salvage attempt and primary amputation.

Cases were selected as per the following inclusion criteria: An editorial emphasizing this view, to be submitted to the Journal of Trauma, is in preparation.

We indicated this precise point — that MESS was a “snapshot in time” which needed to be modified serially as new limb salvage techniques became available — when we initially presented this scoring system. This experience reflected recent observations from other trauma centers e. Extreity results are also found by Lin et al. In the retrospective study, maximum period of follow-up was done at the end of six and half years and minimum period of follow up was done at the end of two and half years.

Management After initial stabilization and resuscitation in the Emergency Department, urgent orthopedics consultation or transfer to a higher level of care is critical as time of ischemia plays a significant role in the MESS. The occurrence of just one of two absolute indications complete posterior tibial nerve disruption in adults; crush injuries with longer than wcore hours of warm ischemia time warrants primary amputation, while at least two of three relative indications serious associated polytrauma, severe ipsilateral foot trauma or projected long course to full recovery must be present to reach that decision.


This is a very important question. S, Sewagram -WardhaIndia. Frequently, overzealous attempts at limb salvage with prolonged unsuccessful attempts at rehabilitation result in a functionally useless limb, chronic disability and pain and may be followed later by delayed amputation. Journal of Trauma, MESS could provide an early prognosis on the injured limb at time of Emergency Department or initial contact with healthcare system.

Unfortunately, while limb preservation is frequently possible, the salvaged limb may have significant functional deficits and may have ultimately required secondary ablation. Vascular repair, severigy indicated, and primary fracture alignment and stabilization were carried out.

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Trauma Scoring Systems – Trauma – Orthobullets

However, when the limbs which required delayed amputation were analyzed, the LSI was slightly more accurate in predicting amputation. He is also a clinical professor of surgery at the University of Washington School of Medicine. National Center for Biotechnology InformationU. Adequate physiotherapy was carried out depending upon the circumstances.

We caution to keep realistic extrwmity regarding the ultimate functional result. LSI manglsd formulated based on the degree of injury to the arterial, nerve, bone, muscle, skin, venous and warm ischemia time.

Three patients had not reported for follow-up and two patients had died before complete follow-up.