High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting

(1) Background: The Gustilo–Anderson (G/A) grading system is a universally accepted tool used to classify high-grade limb open fractures. The purpose of this study is to find early independent predictors of amputation in emergency settings. (2) Methods: A retrospective analysis involving patients tr...

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Autores principales:	Michele Altomare, Stefano Granieri, Stefano Piero Bernardo Cioffi, Andrea Spota, Silvia Azisa Basilicò, Osvaldo Chiara, Stefania Cimbanassi
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	trauma Gustilo–Anderson extremity injuries Mangled Extremity Severity Score Science Q
Acceso en línea:	https://doaj.org/article/6fa36fce98b9476f827aef9602bb8239
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spelling	oai:doaj.org-article:6fa36fce98b9476f827aef9602bb82392021-11-25T18:11:21ZHigh-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting10.3390/life111112262075-1729https://doaj.org/article/6fa36fce98b9476f827aef9602bb82392021-11-01T00:00:00Zhttps://www.mdpi.com/2075-1729/11/11/1226https://doaj.org/toc/2075-1729(1) Background: The Gustilo–Anderson (G/A) grading system is a universally accepted tool used to classify high-grade limb open fractures. The purpose of this study is to find early independent predictors of amputation in emergency settings. (2) Methods: A retrospective analysis involving patients treated at our center between 2010 and 2016 was conducted. Patients with at least one G/A grade III fracture or post-traumatic amputation were included. Three groups were identified: G/A IIIA (A group), G/A IIIB-C (BC group), and Amputation group (AMP group). Each group was further divided into two subgroups considering timing of coverage (early vs. delayed). Univariate and multivariate logistic regression models were developed to identify independent predictors of the limb’s outcome. (3) Results: One-hundred-six patients with G/A III A-B-C fractures or amputation of the affected limb were selected from the Niguarda Hospital Trauma Registry. The patients were divided into the A group (26), BC group (66), and AMP group (14). The rate of infectious complications following early or delayed coverage was evaluated: A group, 9.1% vs. 66.7% (<i>p</i> > 0.05); BC group, 32% vs. 63.6% (<i>p</i> = 0.03); and AMP group, 22% vs. 18.5% (<i>p</i> > 0.05). After further recategorization, the BC subgroups were analyzed: multivariate logistic regression model identified systolic blood pressure (SBP) <90 mmHg (<i>p</i> = 0.03) and Mangled Extremity Severity Score MESS ≥ 7 (<i>p</i> = 0.001) were determined to be independent predictors of limb amputation. (4) Conclusion: MESS and SBP serve as predictors of amputation. Based on the results, we propose a new management algorithm for mangled extremities. Early coverage is related to lower rates of infectious complications. Referral to high-volume centers with specific expertise is mandatory to guarantee the best results.Michele AltomareStefano GranieriStefano Piero Bernardo CioffiAndrea SpotaSilvia Azisa BasilicòOsvaldo ChiaraStefania CimbanassiMDPI AGarticletraumaGustilo–Andersonextremity injuriesMangled Extremity Severity ScoreScienceQENLife, Vol 11, Iss 1226, p 1226 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	trauma Gustilo–Anderson extremity injuries Mangled Extremity Severity Score Science Q
spellingShingle	trauma Gustilo–Anderson extremity injuries Mangled Extremity Severity Score Science Q Michele Altomare Stefano Granieri Stefano Piero Bernardo Cioffi Andrea Spota Silvia Azisa Basilicò Osvaldo Chiara Stefania Cimbanassi High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting
description	(1) Background: The Gustilo–Anderson (G/A) grading system is a universally accepted tool used to classify high-grade limb open fractures. The purpose of this study is to find early independent predictors of amputation in emergency settings. (2) Methods: A retrospective analysis involving patients treated at our center between 2010 and 2016 was conducted. Patients with at least one G/A grade III fracture or post-traumatic amputation were included. Three groups were identified: G/A IIIA (A group), G/A IIIB-C (BC group), and Amputation group (AMP group). Each group was further divided into two subgroups considering timing of coverage (early vs. delayed). Univariate and multivariate logistic regression models were developed to identify independent predictors of the limb’s outcome. (3) Results: One-hundred-six patients with G/A III A-B-C fractures or amputation of the affected limb were selected from the Niguarda Hospital Trauma Registry. The patients were divided into the A group (26), BC group (66), and AMP group (14). The rate of infectious complications following early or delayed coverage was evaluated: A group, 9.1% vs. 66.7% (<i>p</i> > 0.05); BC group, 32% vs. 63.6% (<i>p</i> = 0.03); and AMP group, 22% vs. 18.5% (<i>p</i> > 0.05). After further recategorization, the BC subgroups were analyzed: multivariate logistic regression model identified systolic blood pressure (SBP) <90 mmHg (<i>p</i> = 0.03) and Mangled Extremity Severity Score MESS ≥ 7 (<i>p</i> = 0.001) were determined to be independent predictors of limb amputation. (4) Conclusion: MESS and SBP serve as predictors of amputation. Based on the results, we propose a new management algorithm for mangled extremities. Early coverage is related to lower rates of infectious complications. Referral to high-volume centers with specific expertise is mandatory to guarantee the best results.
format	article
author	Michele Altomare Stefano Granieri Stefano Piero Bernardo Cioffi Andrea Spota Silvia Azisa Basilicò Osvaldo Chiara Stefania Cimbanassi
author_facet	Michele Altomare Stefano Granieri Stefano Piero Bernardo Cioffi Andrea Spota Silvia Azisa Basilicò Osvaldo Chiara Stefania Cimbanassi
author_sort	Michele Altomare
title	High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting
title_short	High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting
title_full	High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting
title_fullStr	High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting
title_full_unstemmed	High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting
title_sort	high-grade limbs open fractures: time to find milestones in the emergency setting
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/6fa36fce98b9476f827aef9602bb8239
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High-Grade Limbs Open Fractures: Time to Find Milestones in the Emergency Setting

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