Complications following limb-threatening lower extremity trauma.
OBJECTIVE
Our objective is to report the nature and incidence of major complications after severe lower extremity trauma.


METHODS
Multicenter, prospective, observational study.


METHODS
Eight level-1 trauma centers.


METHODS
Five hundred forty-five patients were followed for 2 years.


METHODS
Amputation or reconstruction.


METHODS
The type and number of complications associated with these injuries were recorded at baseline, 3-, 6-, 12-, and 24-month intervals.


RESULTS
One hundred forty-nine underwent amputation during the initial hospitalization. The revision amputation rate was 5.4%. Among the amputation group, a complication was noted most frequently at 3 months (24.8%), and the most commonly seen complication was wound infection (34.2%). Wound complications including dehiscence (13.4%) were seen more commonly in the amputation group. Three hundred seventy-one limb reconstructions were performed with 25 patients (3.9%) requiring late amputation. The most frequently reported complication was at 6 months for the salvage group (37.7%), and the most commonly seen complication was wound infection (23.2%). Not surprisingly, osteomyelitis (8.6%) and nonunions (31%) were seen more commonly in the salvage group. Complications of wound infection, osteomyelitis, nonunion, malunion, and prominent hardware resulted in rehospitalization in at least one-third of patients. However, patients who underwent reconstruction were more likely to be hospitalized for these complications.


CONCLUSIONS
Patients with severe lower extremity injuries can expect a significant number of complications, most notably wound infection, nonunion, wound necrosis, and osteomyelitis. A large portion of these will require additional inpatient or operative treatment. Patients electing for reconstruction can expect a higher risk of complications.
Harris
Anthony M
AM
Department of Orthopaedics Trauma Division, Shands Jacksonville, Jacksonville, FL 32209, USA. pod1999@aol.com
Althausen
Peter L
PL
Kellam
James
J
Bosse
Michael J
MJ
Castillo
Renan
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D005599:Fractures, Ununited / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006801:Humans; D015994:Incidence; D007869:Leg Injuries / Q000534:rehabilitation / Q000601:surgery*; D023821:Limb Salvage; D008875:Middle Aged; D009336:Necrosis; D010019:Osteomyelitis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012086:Reoperation; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D014481:United States / Q000453:epidemiology; D055815:Young Adult