Complications following limb-threatening lower extremity trauma.

Abstract

OBJECTIVE:

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

DESIGN:

Multicenter, prospective, observational study.

SETTING:

Eight level-1 trauma centers.

PATIENTS/PARTICIPANTS:

Five hundred forty-five patients were followed for 2 years.

INTERVENTION:

Amputation or reconstruction.

MAIN OUTCOME MEASUREMENTS:

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

RESULTS:

One hundred forty-nine 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. Three hundred seventy-one 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.

• Authors: Anthony M Harris, Peter L Althausen, James Kellam, Michael J Bosse, Renan Castillo, Lower Extremity Assessment Project (LEAP) Study Group
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 23 Issue 1 Pg. 1-6 (Jan 2009) ISSN: 1531-2291 [Electronic] United States
• PMID: 19104297 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Topics

• Adolescent
• Adult
• Aged
• Amputation, Surgical
• Fractures, Ununited (epidemiology, etiology, pathology)
• Humans
• Incidence
• Leg Injuries (rehabilitation, surgery)
• Limb Salvage
• Middle Aged
• Necrosis
• Osteomyelitis (epidemiology, etiology, pathology)
• Postoperative Complications
• Prospective Studies
• Plastic Surgery Procedures
• Reoperation
• Surgical Wound Infection (epidemiology, etiology, pathology)
• United States (epidemiology)
• Young Adult