Utility of mangled extremity severity score in severely injured lower limbs

  • Toya Raj Bhatta Tribhuvan University Teaching Hospital . Maharajganj, Kathmandu , Nepal.


Introduction: Massive lower extremity trauma,in particular open tibial fractures with associated vascular injuries, present an immediate and complex decision-making challenge between a limb salvage attempt and primary amputation. Medical and surgical advances of the past two decades have improved the ability to reconstruct severely injured limb. Limbs that once would have been amputated are now routinely managed with complex reconstruction protocol.Mangled extremity severity score is one of the scoring systems to predict the fate of limbs after severe limb injuries.Methods: Patients fulfilling the inclusion criteria were evaluated with MESS, at the same time treatment protocol for management of injuries of lower limb were followed independently by attending orthopedic surgeon. Mean MESS for salvaged and amputated limbs were calculated and its reliability for prediction of fate of injured limb was assessed using software SPSS v16.Result: The age of patient ranges from 10 to 65 yrs with mean age 35.83. The most common mechanism of injury was Road Traffic Accident followed by fall from height. The mean MESS score for salvaged limbs was 4.18 and for amputated limbs was 8.12 suggesting significant difference in mean scores. The sensitivity (the probability that limbs requiring amputation will have MESS at or above 7) was found to be 75%. The specificity of MESS (the probability that salvage limbs will have MESS < 7) was 95.45%.Conclusion: MESS is a reliable indicator in decision making process whether a limb can be salvaged or needs amputation. The mangled lower extremity with the score of less than 7 may be salvaged and 7 or more may need amputation.

Author Biography

Toya Raj Bhatta, Tribhuvan University Teaching Hospital . Maharajganj, Kathmandu , Nepal.
Department of Surgery Institute of Medicine,


1 Lance RH. Limb reconstruction versus amputation decision making in massive lower extremity trauma. Clinical Orthopedics and Related Research 1989;243
2 O'Sullivan ST, O'Sullivan M, Pasha N, O'Shaghnessy M, O'Connor TP. Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices. Injury 1997;24:639-42.
3 Pimple MK, Desai MM, Hirak. The utility of MESS in mangled extremities. Indian J Orthop 2002; 369:168-73.
4 MJ Bosse et al. An analysis of outcome of reconstruction or amputation after leg threatening injuries. N Engl J Med 2002;347:1924-31
5 Canale ST, Beaty HJ. Campbell's operative orthopedics. 12th ed. Philidelphia; Mosby Elsevier; 2013.pp642
6 Sharma, S., et al. Critical evaluation of mangled extremity severity scoring system in Indian patients. Injury, 2003. 34(7): p. 493-496.
7 Helfet, D., et al. Limb salvage versus amputation: preliminary results of the Mangled Extremity Severity Score. Clinical orthopaedics and related research, 1990. 256: p. 80-86.

8 Kumar, M.K., C. Badole, and K. Patond. Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs. Indian journal of orthopaedics, 2007. 41(3): p. 183.

9 Lucian Fodor, Raluca Sobec, Laura Sita-Alb, Marius Fodor, Constantin Ciuce. Mangled lower extremity: can we trust the amputation scores?. Int J Burn Trauma 2012; 2(1): 51-58

10 Boss MJ, Mackenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al . A prospective evaluation of clinical utility of the lower extremity injury-severity scores. J Bone Joint Surg Am 2001;83:3-14.
How to Cite
BHATTA, Toya Raj. Utility of mangled extremity severity score in severely injured lower limbs. J Soc Surg Nep, [S.l.], v. 18, n. 1, aug. 2016. ISSN 2392-4772. Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=195>. Date accessed: 19 may 2024.
Original Article


Amputation; MESS; Salvage