presents
Wheeless' Textbook of Orthopaedics
Tracking Pixel
Search Site by Word
My Account

Mangled Extremity Severity Score (MESS)




                                                                           - from Johansen et.al. 1990)
Skeletal / soft-tissue injury
     Low energy (stab; simple fracture; pistol gunshot wound)            1
     Medium energy (open or multiple fractures, dislocation)              2
     High energy (high speed MVA or rifle GSW)                               3
     Very high energy (high speed trauma + gross contamination)      4
Limb ischemia
     Pulse reduced or absent but perfusion normal                            1*
     Pulseless; paresthesias, diminished capillary refill                      2
     Cool, paralyzed, insensate, numb                                              3*
Shock
     Systolic BP always > 90 mm Hg                                               0
     Hypotensive transiently                                                             1
     Persistent hypotension                                                             2
Age (years)
     < 30                                                                                        0
     30-50                                                                                       1
     > 50                                                                                        2

* Score doubled for ischemia > 6 hours





- Discussion:
    - in the report by Bosse et al (JBJS 2001), the authors studied the clinical utility of five lower
           extremity injury-severity scoring systems;
           - 546 high-energy lower-extremity injuries were prospectively evaluated with use of five injury-severity
                  scoring systems for lower-extremity trauma designed to assist in the decision-making process for
                  the care of patients with such injuries;
           - 407 limbs remained in the salvage pathway six months after the injury;
           - the analysis did not validate the clinical utility of any of the lower-extremity injury-severity scores;
           - high specificity of the scores in all of the patient subgroups did confirm that low scores could be used to predict limb-salvage potential;
           - the converse was not true - low sensitivity of the indices failed to support the validity of the scores as predictors of amputation.
           - see tibial defect reconstruction and amputation following tibia fractures




Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.

Amputations and Artificial Limbs--Symposium: Limb Salvage Versus Amputation: Preliminary Results of the Mangled Extremity Severity Score.

A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores
      Michael J. Bosse, MD et al. (J Bone Joint Surg [Am] 83-A: 3-14, 2001)

To Reconstruct or Not to Reconstruct?

An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.










Original Text by Clifford R. Wheeless, III, MD.