title: Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma.
abstract: BACKGROUND
  Factors thought to influence the decision for limb salvage include injury severity, physiologic reserve of the patient, and characteristics of the patient and their support system.
  
  
  METHODS
  Eligible patients were between the ages of 16 and 69 with Gustilo type IIIB and IIIC tibial fractures, dysvascular limbs resulting from trauma, type IIIB ankle fractures, or severe open midfoot or hindfoot injuries. Data collected at enrollment relevant to the decision-making process included injury characteristics and its treatment, and the nature and severity of other injuries. Logistic regression and stepwise modeling were used to determine the effect of each covariate on the variable salvage/ amputation.
  
  
  RESULTS
  Of 527 patients included in the analysis, 408 left the hospital with a salvaged limb. Of the 119 amputations performed, 55 were immediate and 64 were delayed. The multivariate analysis confirmed the bivariate analysis: all injury characteristics remained significant predictors of limb status with the exception of bone loss; and soft tissue injury and absence of plantar sensation were the most important factors in accounting for model validity.
  
  
  CONCLUSIONS
  Soft tissue injury severity has the greatest impact on decision making regarding limb salvage versus amputation.
authors.affiliation: Department of Orthopaedics, University of Minnesota, Minneapolis, Minnesota 55455, USA. swion001@tc.umn.edu
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bosse
authors.forename: James F
authors.initials: JF
authors.lastname: Kellam
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Burgess
authors.forename: Lawrence X
authors.initials: LX
authors.lastname: Webb
authors.forename: Marc F
authors.initials: MF
authors.lastname: Swiontkowski
authors.forename: Roy
authors.initials: R
authors.lastname: Sanders
authors.forename: Alan L
authors.initials: AL
authors.lastname: Jones
authors.forename: Mark P
authors.initials: MP
authors.lastname: McAndrew
authors.forename: Brendan
authors.initials: B
authors.lastname: Patterson
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McCarthy
authors.forename: Charles A
authors.initials: CA
authors.lastname: Rohde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D015331:Cohort Studies; D003657:Decision Making; D050723:Fractures, Bone / Q000601:surgery; D013502:General Surgery; D006801:Humans; D007348:Insurance, Health; D007869:Leg Injuries / Q000601:surgery*; D016015:Logistic Models; D008875:Middle Aged; D009985:Orthopedics; D017063:Outcome Assessment, Health Care; D019651:Plastic Surgery Procedures; D017695:Soft Tissue Injuries / Q000601:surgery; D013997:Time Factors; D015599:Trauma Severity Indices