Factors Influencing the Decision to Amputate or Reconstruct after High-Energy Lower Extremity Trauma

TLDR

Factors influencing limb‑salvage decisions include injury severity, patient physiologic reserve, and patient and support‑system characteristics. The authors performed logistic regression on 527 high‑energy tibial, ankle, or foot fracture patients to model how injury characteristics predict limb salvage versus amputation. In the cohort, 77% of patients had limb salvage, and multivariate analysis identified soft‑tissue injury severity and loss of plantar sensation as the strongest predictors of amputation, whereas bone loss was not significant.

Abstract

Background Factors thought to influence the decision for limb salvage include injury severity, physiologic reserve of the patient, and characteristics of the patient and their support system. Methods Eligible patients were between the ages of 16 and 69 with Gustilo type IIIB and IIIC tibial fractures, dysvascular limbs resulting from trauma, type IIIB ankle fractures, or severe open midfoot or hindfoot injuries. Data collected at enrollment relevant to the decision-making process included injury characteristics and its treatment, and the nature and severity of other injuries. Logistic regression and stepwise modeling were used to determine the effect of each covariate on the variable salvage/ amputation. Results Of 527 patients included in the analysis, 408 left the hospital with a salvaged limb. Of the 119 amputations performed, 55 were immediate and 64 were delayed. The multivariate analysis confirmed the bivariate analysis: all injury characteristics remained significant predictors of limb status with the exception of bone loss; and soft tissue injury and absence of plantar sensation were the most important factors in accounting for model validity. Conclusion Soft tissue injury severity has the greatest impact on decision making regarding limb salvage versus amputation.