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      Successful megaprosthesis in a nearly amputated lower extremity after crush injury: A case report and literature review

      case-report

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          Abstract

          Crush injury is one of the most challenging decisions for a surgeon to decide whether to proceed with an amputation or salvage a limb.

          We presented a 24-year-old man who complained of having suffered a crushed thigh 12 h before admission to the hospital. The patient was driving a truck and hit the iron bridge barrier, which penetrated his left thigh. The patient's left foot was cold, pallid, and pulseless, with a MESS score of 11. The femur x-ray showed a displaced fracture of the left femur associated with a 15 cm bone defect. The patient was diagnosed with a crush injury on the left femur with vascular compromise.

          We performed a proximal femoral megaprosthesis for a crush injury on the lower extremity, After the sixth year's follow-up, it shows a good outcome and increased quality of life for this patient. In addition, there was an improvement in the Harris Hip Score and EQ5D score.

          Megaprosthesis used to treat a crush injury revealed good functional outcomes despite the MESS score of 11. A multi-professional approach to the patient is essential for decision-making regarding limb salvage rather than the use of a score.

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          The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines

          Riaz Agha, Thomas Franchi, Catrin Sohrabi … (2020)
          The SCARE Guidelines were first published in 2016 and were last updated in 2018. They provide a structure for reporting surgical case reports and are used and endorsed by authors, journal editors and reviewers, in order to increase robustness and transparency in reporting surgical cases. They must be kept up to date in order to drive forwards reporting quality. As such, we have updated these guidelines via a DELPHI consensus exercise.
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            Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review.

            Eric R Henderson, John S Groundland, Elisa Pala … (2011)
            Massive endoprostheses provide orthopaedic oncologists with many reconstructive options after tumor resection, although failure rates are high. Because the number of these procedures is limited, failure of these devices has not been studied or classified adequately. This investigation is a multicenter review of the use of segmental endoprostheses with a focus on the modes, frequency, and timing of failure. Retrospective reviews of the operative databases of five institutions identified 2174 skeletally mature patients who received a large endoprosthesis for tumor resection. Patients who had failure of the endoprosthesis were identified, and the etiology and timing of failure were noted. Similar failures were tabulated and classified on the basis of the risk of amputation and urgency of treatment. Statistical analysis was performed to identify dependent relationships among mode of failure, anatomic location, and failure timing. A literature review was performed, and similar analyses were done for these data. Five hundred and thirty-four failures were identified. Five modes of failure were identified and classified: soft-tissue failures (Type 1), aseptic loosening (Type 2), structural failures (Type 3), infection (Type 4), and tumor progression (Type 5). The most common mode of failure in this series was infection; in the literature, it was aseptic loosening. Statistical dependence was found between anatomic location and mode of failure and between mode of failure and time to failure. Significant differences were found in the incidence of failure mode Types 1, 2, 3, and 4 when polyaxial and uniaxial joints were compared. Significant dependence was also found between failure mode and anatomic location in the literature data. There are five primary modes of endoprosthetic failure, and their relative incidences are significantly different and dependent on anatomic location. Mode of failure and time to failure also show a significant dependence. Because of these relationships, cumulative reporting of segmental failures should be avoided because anatomy-specific trends will be missed. Endoprosthetic design improvements should address failure modes specific to the anatomic location.
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              Objective criteria accurately predict amputation following lower extremity trauma.

              T Hansen, Krisztina K. Johansen, Alison Daines … (1990)
              MESS (Mangled Extremity Severity Score) is a simple rating scale for lower extremity trauma, based on skeletal/soft-tissue damage, limb ischemia, shock, and age. Retrospective analysis of severe lower extremity injuries in 25 trauma victims demonstrated a significant difference between MESS values for 17 limbs ultimately salvaged (mean, 4.88 +/- 0.27) and nine requiring amputation (mean, 9.11 +/- 0.51) (p less than 0.01). A prospective trial of MESS in lower extremity injuries managed at two trauma centers again demonstrated a significant difference between MESS values of 14 salvaged (mean, 4.00 +/- 0.28) and 12 doomed (mean, 8.83 +/- 0.53) limbs (p less than 0.01). In both the retrospective survey and the prospective trial, a MESS value greater than or equal to 7 predicted amputation with 100% accuracy. MESS may be useful in selecting trauma victims whose irretrievably injured lower extremities warrant primary amputation.
              Article 0 comments Cited 105 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Romy Deviandri
                Journal
                Journal ID (nlm-ta): Trauma Case Rep
                Journal ID (iso-abbrev): Trauma Case Rep
                Title: Trauma Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2352-6440
                Publication date PMC-release: 09 October 2023
                Publication date Collection: December 2023
                Publication date (Electronic): 09 October 2023
                Volume: 48
                Electronic Location Identifier: 100942
                Affiliations
                [a ]Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
                [b ]Department of Physiology, Faculty of Medicine, Universitas Riau, Pekanbaru, Indonesia
                [c ]Department of Surgery, Division of Orthopedics, Faculty of Medicine, Universitas Riau, Arifin Achmad Hospital, Pekanbaru, Indonesia
                [d ]Department of Orthopedics, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia
                Author notes
                [* ]Corresponding author at: Faculty of Medicine, Universitas Riau, Diponegoro street no 1, Pekanbaru 28133, Indonesia. r.deviandri@ 123456rug.nl romydeviandri@ 123456lecturer.unri.ac.id
                Article
                Publisher Item ID: S2352-6440(23)00189-9 Publisher ID: 100942
                DOI: 10.1016/j.tcr.2023.100942
                PMC ID: 10577054
                PubMed ID: 37846227
                SO-VID: 07c257c8-2f4b-4b34-aa7c-19a3cdb81705
                Copyright © © 2023 The Authors
                License:

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                Date accepted : 22 September 2023
                Categories
                Subject: Case Report

                Keywords: crush injury,mess score,limb salvage,megaprosthesis
                Data availability:
                Keywords: crush injury, mess score, limb salvage, megaprosthesis

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