Harris, J Orthop Trauma 2009 - Complications Following Limb-Threatening Lower Extremity Trauma

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Complications Following Limb-Threatening Lower Extremity Trauma

Harris, Lower Extremity Assessment Project (LEAP) Study Group, et al.·J Orthop Trauma·2009·339 citations·Prospective cohort

Purpose

Our objective is to report the nature and incidence of major complications after severe lower extremity trauma.

Methods

Design: Multicenter, prospective, observational study.

Setting: Eight level-1 trauma centers.

Patients: 545 patients were followed for 2 years.

Intervention: Amputation or reconstruction.

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

Results

149 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.
371 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.

Copyright remains with the authors and publisher.

Complications Following Limb-Threatening Lower Extremity Trauma

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Complications Following Limb-Threatening Lower Extremity Trauma

Harris, Lower Extremity Assessment Project (LEAP) Study Group, et al.·J Orthop Trauma·2009·339 citations·Prospective cohort

Purpose

Our objective is to report the nature and incidence of major complications after severe lower extremity trauma.

Methods

Design: Multicenter, prospective, observational study.

Setting: Eight level-1 trauma centers.

Patients: 545 patients were followed for 2 years.

Intervention: Amputation or reconstruction.

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

Results

149 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.
371 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.

Copyright remains with the authors and publisher.

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