title: Third degree open fractures and traumatic sub-/total amputations of the upper extremity: Outcome and relevance of the Mangled Extremity Severity Score.
abstract: Third degree open fractures and traumatic sub-/total amputations of the upper extremity represent severe injuries and are associated with a high rate of functional impairment of the affected extremity. More than 20 years ago, the Mangled Extremity Severity Score (MESS) was introduced to predict amputation following severe lower extremity trauma. However, there have been few studies evaluating MESS in connection with the mangled upper limb.
  
  
  
  A retrospective medical chart review was performed of all patients diagnosed with the aforementioned fractures of the upper extremity treated at the Department of trauma surgery (level I trauma center) and the Clinical division of plastic and reconstructive surgery at the general hospital of Vienna between 1994 and 2014.
  
  
  
  Fifty-four out of 606 patients (9%) suffered from a total of 61 third degree open fractures or traumatic sub-/total amputations of the upper extremity (Gustilo-Anderson, type IIIA, n=30; Gustilo-Anderson, type IIIB, n=15; Gustilo-Anderson, type IIIC, n=9; traumatic sub-/total amputations, n=7). Thirty-seven out of 54 patients (69%) suffered fractures of the forearm, 10/54 (19%) patients of the humerus and 7/54 (13%) patients of the forearm and the humerus. The median MESS and Injury Severity Score (ISS) for all patients was 5 (range: 3-10) and 9 (range: 4-50), respectively. Seventeen out of 54 patients (31%) were diagnosed with a MESS≥7. Twenty-one out of 54 patients (39%) suffered severe vascular injuries and 22/54 (41%) patients suffered injuries of neural structures. Throughout the therapy process, 6/54 (11%) patients died. Definite limb salvage was achieved in 45 (94%) of the 48 survivors, of whom 9/45 (20%) subjects had a MESS≥7.
  
  
  
  It became apparent that definite limb salvage could be achieved in the mangled upper extremity regardless of MESS. It should be noted that in the current study, limb functionality was not assessed. However, without a standardized scoring system, there might be significant risk of salving dysfunctional upper limbs.
  
  
  
  IV: retrospective or historical series.
authors.affiliation: Medical university of Vienna, clinical division of plastic and reconstructive surgery, department of surgery, 18-20, Waehringer Guertel, 1090 Vienna, Austria; Medical university of Vienna, department of trauma surgery, general hospital, Vienna, Austria. Electronic address: alexandra.fochtmann@meduniwien.ac.at.
authors.forename: A
authors.initials: A
authors.lastname: Fochtmann
authors.affiliation: Medical university of Vienna, department of trauma surgery, general hospital, Vienna, Austria. Electronic address: harald.binder@meduniwien.ac.at.
authors.forename: H
authors.initials: H
authors.lastname: Binder
authors.affiliation: Medical university of Vienna, department of trauma surgery, general hospital, Vienna, Austria. Electronic address: gregor.rettl@meduniwien.ac.at.
authors.forename: G
authors.initials: G
authors.lastname: Rettl
authors.affiliation: Medical university of Vienna, department of trauma surgery, general hospital, Vienna, Austria. Electronic address: julia.starlinger@meduniwien.ac.at.
authors.forename: J
authors.initials: J
authors.lastname: Starlinger
authors.affiliation: Medical university of Vienna, clinical division of plastic and reconstructive surgery, department of surgery, 18-20, Waehringer Guertel, 1090 Vienna, Austria. Electronic address: oskar.aszmann@meduniwien.ac.at.
authors.forename: O
authors.initials: O
authors.lastname: Aszmann
authors.affiliation: Medical university of Vienna, department of trauma surgery, general hospital, Vienna, Austria. Electronic address: kambiz.sarahrudi@meduniwien.ac.at.
authors.forename: K
authors.initials: K
authors.lastname: Sarahrudi
authors.affiliation: Medical university of Vienna, department of trauma surgery, general hospital, Vienna, Austria. Electronic address: stefan.hajdu@meduniwien.ac.at.
authors.forename: S
authors.initials: S
authors.lastname: Hajdu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D000673:Amputation, Traumatic / Q000145:classification / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005543:Forearm Injuries / Q000145:classification / Q000401:mortality / Q000601:surgery*; D005597:Fractures, Open / Q000145:classification / Q000401:mortality / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000401:mortality / Q000601:surgery*; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D057772:Vascular System Injuries / Q000401:mortality / Q000601:surgery; D055815:Young Adult
keywords: Mangled upper limb; Soft tissue defect; Traumatic sub-/total amputations of the upper extremity; Upper extremity vascular injury; Upper limb salvage