An analysis of outcomes of reconstruction or amputation after leg-threatening injuries.
BACKGROUND
Limb salvage for severe trauma has replaced amputation as the primary treatment in many trauma centers. However, long-term outcomes after limb reconstruction or amputation have not been fully evaluated.


METHODS
We performed a multicenter, prospective, observational study to determine the functional outcomes of 569 patients with severe leg injuries resulting in reconstruction or amputation. The principal outcome measure was the Sickness Impact Profile, a multidimensional measure of self-reported health status (scores range from 0 to 100; scores for the general population average 2 to 3, and scores greater than 10 represent severe disability). Secondary outcomes included limb status and the presence or absence of major complications resulting in rehospitalization.


RESULTS
At two years, there was no significant difference in scores for the Sickness Impact Profile between the amputation and reconstruction groups (12.6 vs. 11.8, P=0.53). After adjustment for the characteristics of the patients and their injuries, patients who underwent amputation had functional outcomes that were similar to those of patients who underwent reconstruction. Predictors of a poorer score for the Sickness Impact Profile included rehospitalization for a major complication, a low educational level, nonwhite race, poverty, lack of private health insurance, poor social-support network, low self-efficacy (the patient's confidence in being able to resume life activities), smoking, and involvement in disability-compensation litigation. Patients who underwent reconstruction were more likely to be rehospitalized than those who underwent amputation (47.6 percent vs. 33.9 percent, P=0.002). Similar proportions of patients who underwent amputation and patients who underwent reconstruction had returned to work by two years (53.0 percent and 49.4 percent, respectively).


CONCLUSIONS
Patients with limbs at high risk for amputation can be advised that reconstruction typically results in two-year outcomes equivalent to those of amputation.
Bosse
Michael J
MJ
Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA. mbosse@carolinas.org
MacKenzie
Ellen J
EJ
Kellam
James F
JF
Burgess
Andrew R
AR
Webb
Lawrence X
LX
Swiontkowski
Marc F
MF
Sanders
Roy W
RW
Jones
Alan L
AL
McAndrew
Mark P
MP
Patterson
Brendan M
BM
McCarthy
Melissa L
ML
Travison
Thomas G
TG
Castillo
Renan C
RC
D000203:Activities of Daily Living; D000328:Adult; D000671:Amputation, Surgical; D005260:Female; D006760:Hospitalization; D006801:Humans; D007869:Leg Injuries / Q000145:classification / Q000534:rehabilitation / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D017057:Medically Uninsured; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011446:Prospective Studies; D020127:Recovery of Function; D012044:Regression Analysis; D018434:Sickness Impact Profile; D012944:Social Support; D012959:Socioeconomic Factors