Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-23T06:24:45.296Z Has data issue: false hasContentIssue false
  • English
  • Français

Key Points of Preliminary Treatment for Patients with Extremity Trauma Based on Analysis of Amputation Cases

Published online by Cambridge University Press:  07 October 2019

Yao Jiang Open the ORCID record for Yao Jiang [Opens in a new window] ,
Ming-Hua Liu ,
Qiang Xiang  and
Yun-Gui Wang
Yao Jiang
Affiliation:
Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
Ming-Hua Liu
Affiliation:
Department of Emergency, Southwest Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
Qiang Xiang*
Affiliation:
Department of Emergency, Southwest Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
Yun-Gui Wang*
Affiliation:
Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China
*
Correspondence: Qiang Xiang Department of Emergency, Southwest Hospital Army Medical University (Third Military Medical University) No. 30 Gaotanyan Road Shapingba District Chongqing 400038, China E-mail: [email protected] Yun-Gui Wang Army Medical University No. 30 Gaotanyan Road Shapingba District Chongqing 400038, China E-mail: [email protected]
Correspondence: Qiang Xiang Department of Emergency, Southwest Hospital Army Medical University (Third Military Medical University) No. 30 Gaotanyan Road Shapingba District Chongqing 400038, China E-mail: [email protected] Yun-Gui Wang Army Medical University No. 30 Gaotanyan Road Shapingba District Chongqing 400038, China E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Severe trauma can lead to amputation of limbs. There is no golden standard or comprehensive evaluation indicator for amputation. It is difficult for the primary rescue organization to focus on the most essential indicators and to determine whether to perform amputation or take proper operation.

Problem:

For medical staff in first-line medical teams for disaster relief or in a common primary hospital, what indicators should they focus on to keep the patient’s limbs when they receive wounded patients with severe trauma?

Methods:

A retrospective case-control study was performed based on the patients with severe trauma from January 2013 through December 2018 in the emergency department of Southwest Hospital (Shapingba District, Chongqing, China), a Level I trauma center. A total of 165 cases were divided into amputation group (n = 79) and non-amputation control group (n = 86), which had severe skin and muscle injury but without amputation. The causes of trauma and the special cases were analyzed. Binary logistic regression models were used to find the essential indicators for amputation.

Conclusions:

Neurovascular injury with delayed treatment was the most decisive indicator leading to amputation, and time phase was also important for limb salvage. Preliminary treatment of disaster victims and patients with severe trauma should focus on neurovascular status and timely delivery.

Keywords

disaster medicineprehospital emergency caretraumatic amputation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 6 , December 2019 , pp. 592 - 595
Copyright
© World Association for Disaster and Emergency Medicine 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

World Health Organization (WHO). Global status report on road safety 2018. https://www.who.int/violence_injury_prevention/road_safety_status/2018/en/. Accessed 2018.Google Scholar
Missair, A, Pretto, E A, Visan, A, et al. A matter of life or limb? A review of traumatic injury patterns and anesthesia techniques for disaster relief after major earthquakes. Anesth Analg. 2013;117(4):934–941.CrossRefGoogle ScholarPubMed
Bondurant, FJ, Cotler, HB, Buckle, R, et al. The medical and economic impact of severely injured lower extremities. J Trauma. 1988;28(8):1270–1273.CrossRefGoogle ScholarPubMed
Johansen, K, Daines, M, Howey, T, et al. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30(5):568–573.CrossRefGoogle ScholarPubMed
Gregory, RT, Gould, RJ, Peclet, M, et al. The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity. J Trauma. 1985;25(12):1147–1150.CrossRefGoogle ScholarPubMed
Jie, Z, Jin-Sheng, WU, Peng, S, et al. Options of limb salvage or amputation in severe limb injuries. Chinese Journal of Bone & Joint. 2015.Google Scholar
Bosse, MJ, Mackenzie, EJ, Kellam, JF, et al. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am. 2001;83(1):3–14.CrossRefGoogle ScholarPubMed
Ly, TV, Travison, TG, Castillo, RC, et al. Ability of lower-extremity injury severity scores to predict functional outcome after limb salvage. J Bone Joint Surg Am. 2008;90(8):1738.CrossRefGoogle ScholarPubMed
World Health Organization (WHO). International statistical classification of diseases and related health problems (ICD-10). http://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf. Accessed July 2015.Google Scholar
Perron, AD, Brady, WJ, Keats, TE. Orthopedic pitfalls in the ED: acute compartment syndrome. Am J Emerg Med. 2001;19(5):413–416.CrossRefGoogle ScholarPubMed
Ulmer, T. The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder? J Orthop Trauma. 2002;16(8):572.CrossRefGoogle ScholarPubMed
Moed, BR, Thorderson, PK. Measurement of intracompartmental pressure: a comparison of the slit catheter, side-ported needle, and simple needle. J Bone Joint Surg Am. 1993;75(2):231.CrossRefGoogle ScholarPubMed
Danner, R, Partanen, K, Partanen, J, et al. Iatrogenic compartment syndrome: a follow-up of four cases caused by elastic bandage. Clin Neurol Neurosurg. 1989;91(1):37–43.CrossRefGoogle ScholarPubMed
Akula, M, Gella, S, Shaw, CJ, McShane, P, Mohsen, AM. A meta-analysis of amputation versus limb salvage in mangled lower limb injuries--the patient perspective. Injury. 2011;42(11):1194–1197.CrossRefGoogle ScholarPubMed
Jain, A, Glass, GE, Ahmadi, H, et al. Delayed amputation following trauma increases residual lower limb infection. J Plast Reconstr Aesthet Surg. 2013;66(4):531–537.CrossRefGoogle ScholarPubMed
Williams, ZF, Bools, LM, Adams, A, et al. Early versus delayed amputation in the setting of severe lower extremity trauma. Am Surg. 2015;81(6):564–568.Google ScholarPubMed