This article is more than 5 years old. Information may no longer be current.
New scoring system helps surgeons predict outcomes for open tibial fractures
Indian investigators say the tool effectively helped them focus salvage measures for Gustilo type IIIA and type IIIB open injuries.
Click Here to Manage Email Alerts
SEOUL — Researchers from Ganga Hospital in India devised a trauma score to grade the severity of damage made to covering tissues, bones and functional tissues from open tibia fractures.
Although orthopedic surgeons can use a number of other scoring methods, the current limb injury severity scores "have poor sensitivity and specificity to predict salvage or outcome," said Rajasekaran Shanmuganathan, MD.
Furthermore, "All the scoring systems are designed for ischemic injuries, so if you have an injury that isn't ischemic in nature, it can score you low on these scales," he added.
He presented his findings at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association, here.
Using the new scale, Shanmuganathan and colleagues ranked the severity of tibial fractures from 1 to 5 (least to most severe). Seven comorbid conditions were assigned a score of 2 each.
The scoring system was validated in 109 consecutive open tibial injuries, including 42 Gustilo type IIIA and 67 Gustilo type IIIB, he said.
Salvage and outcome can be measured by dividing injuries into four groups, with group IV associated with the most severe and disabling injuries. Scoring is performed at the end of debridement, he said.
In a recent comparison study, the investigators' trauma score compared favorably with the Mangled Extremity Severity Score (MESS) in terms of sensitivity (98% and 99%, respectively), specificity (100% and 17%), positive predictor value (100% and 97.5%) and negative predictive value (70% and 50%), he said.
A receiver-operating characteristic curve also showed that the area under the curve for this score was better [0.988 (0.013 SEM)] than the MESS [0.938 (0.039 SEM)], according to the study abstract.
"Having the scale makes it easy to discuss treatment plans with the patient and his or her family, because we can show why we made certain care decisions," he said. "The final decision is still the patient's, but the scale helps guide the patient in that decision-making process."
For more information:
- Shanmuganathan R. A score for predicting salvage and outcome in Gustilo type III-A and type IIIB open tibia fractures. F048-2. Presented at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association. Sept. 9-13, 2007. Seoul.