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Wheeless' Textbook of Orthopaedics

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


- Discussion:
    - in the report by Bosse, et al (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







The mangled foot and ankle: results from a 2-year prospective study.

A Prospective Evaluation of the Clinical Utility of the Lower-Extremity Injury-Severity Scores

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

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  

To Reconstruct or Not to Reconstruct?

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

Ability of Lower-Extremity Injury Severity Scores to Predict Functional Outcome After Limb Salvage



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

Last updated by Clifford R. Wheeless, III, MD on Sunday, July 12, 2015 1:41 pm

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