BACKGROUND: Controversy exists regarding management of proximal tibial metaphyseal fractures with severe soft tissue injury. It is unclear whether limb salvage or early amputation results in the best functional and clinical outcomes. QUESTIONS/ PURPOSE: We hypothesized that in this group of patients, there is no difference in functional outcomes, complication rates, clinical outcomes, or objective physical function related to the treatment approach. METHODS: We used the LEAP study database to perform a retrospective comparative review of a subset of patients with proximal tibial metaphyseal fractures (AO/OTA 41A, B, and C) with associated severe soft tissue injuries comparing the outcomes of patients who were treated with either limb salvage or amputation. RESULTS: Although there were major differences in clinical and functional outcomes based on patients' sociodemographics at 2 years, no differences in clinical or functional outcomes were detected regardless of whether amputation or limb salvage was performed. Severity of soft tissue injury was more predictive of outcome than the surgical approach used. CONCLUSIONS: Sociodemographics and soft tissue injury severity are more important than treatment approach for predicting clinical and functional outcomes at 2 years in patients with proximal tibia metaphyseal fractures with severe soft tissue injury. LEVEL OF EVIDENCE: Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.
BACKGROUND: Controversy exists regarding management of proximal tibial metaphyseal fractures with severe soft tissue injury. It is unclear whether limb salvage or early amputation results in the best functional and clinical outcomes. QUESTIONS/ PURPOSE: We hypothesized that in this group of patients, there is no difference in functional outcomes, complication rates, clinical outcomes, or objective physical function related to the treatment approach. METHODS: We used the LEAP study database to perform a retrospective comparative review of a subset of patients with proximal tibial metaphyseal fractures (AO/OTA 41A, B, and C) with associated severe soft tissue injuries comparing the outcomes of patients who were treated with either limb salvage or amputation. RESULTS: Although there were major differences in clinical and functional outcomes based on patients' sociodemographics at 2 years, no differences in clinical or functional outcomes were detected regardless of whether amputation or limb salvage was performed. Severity of soft tissue injury was more predictive of outcome than the surgical approach used. CONCLUSIONS: Sociodemographics and soft tissue injury severity are more important than treatment approach for predicting clinical and functional outcomes at 2 years in patients with proximal tibia metaphyseal fractures with severe soft tissue injury. LEVEL OF EVIDENCE: Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.
Authors: Michael J Bosse; Ellen J MacKenzie; James F Kellam; Andrew R Burgess; Lawrence X Webb; Marc F Swiontkowski; Roy W Sanders; Alan L Jones; Mark P McAndrew; Brendan M Patterson; Melissa L McCarthy; Thomas G Travison; Renan C Castillo Journal: N Engl J Med Date: 2002-12-12 Impact factor: 91.245
Authors: M J Bosse; E J MacKenzie; J F Kellam; A R Burgess; L X Webb; M F Swiontkowski; R W Sanders; A L Jones; M P McAndrew; B M Patterson; M L McCarthy; J K Cyril Journal: J Bone Joint Surg Am Date: 2001-01 Impact factor: 5.284
Authors: Ellen J MacKenzie; Michael J Bosse; James F Kellam; Andrew R Burgess; Lawrence X Webb; Marc F Swiontkowski; Roy Sanders; Alan L Jones; Mark P McAndrew; Brendan Patterson; Melissa L McCarthy; Charles A Rohde Journal: J Trauma Date: 2002-04
Authors: E J MacKenzie; A R Burgess; M P McAndrew; M F Swiontkowski; B M Cushing; B J deLateur; G J Jurkovich; J A Morris Journal: J Orthop Trauma Date: 1993 Impact factor: 2.512