title: Successful salvage of the upper limb after crush injury requiring nine operations: a case report.
abstract: Emergency treatment of amputation is one of the most frequently used therapeutic methods for patients with severe upper limb crush injury with a mangled extremity severity score (MESS) of more than 7. With the development of advanced surgical repair techniques and reconstructive technology, cases that once required amputation can now be salvaged with appropriate management, and some limb functions may also be reserved. A patient with a severe upper limb crush injury with a MESS score of 10 was treated in our hospital. The limb was salvaged after 9 surgeries over 10 months. The follow-up visits over the next 18 months post-injury showed that the shoulder joint functions were rated as "excellent" (90) according to the Neer score, the Harris hip evaluation (HHS) for elbow joint functions was "good" (80), and the patient was very satisfied with the overall therapeutic outcome. We conclude from the successful outcome of this extreme injury that salvage attempts should be the first management choice for upper limbs with complex injuries to save as much function as possible. Amputation should only be adopted when the injury is life-threatening or no more function can be saved. The level of evidence was V.
authors.affiliation: Department of Orthopedics, Jinshan Hospital, Fudan University, Shanghai, China.
authors.forename: Qingmin
authors.initials: Q
authors.lastname: Zeng
authors.forename: Guoping
authors.initials: G
authors.lastname: Cai
authors.forename: Dechang
authors.initials: D
authors.lastname: Liu
authors.forename: Kun
authors.initials: K
authors.lastname: Wang
authors.forename: Xinchao
authors.initials: X
authors.lastname: Zhang
mesh_terms: D001134:Arm Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008875:Middle Aged; D012086:Reoperation
keywords: Crush injury; Trauma; Upper limb