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Predictive factors for primary amputation in trauma patients in a Nigerian University Teaching Hospital
Abstract
Background: The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face.
Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients.
Design: A prospective study of post-traumatic primary limb amputations.
Setting: The Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria from January, 2000 to December, 2004.
Subjects: Sixty six trauma patients admitted through the Accident and Emergency Unit from January 2000 to December 2004.
Results: Sixty six traumatised patient limbs were primarily amputated during the study period.
The male: female ratio was 3.7:1 and means age was 28.6 years ±16.6(range: 4-7lyears). 80.3% of the patients were below forty years. All the patients had a single limb amputation. The mean MESS score was 9.4 ± 1.3 (range: 7.0-12.0). The main predictive factors in trauma at the emergency unit for primary amputation include age, sex , occupation, limb ischaemia, gangrene, severe open fracture, source or nature of injury, presence of shock, delay in hospital presentation, and MESS.
Conclusion: Immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. Identified predictive factors for primary amputation will reduce trauma associated morbidity and mortality.
Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients.
Design: A prospective study of post-traumatic primary limb amputations.
Setting: The Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria from January, 2000 to December, 2004.
Subjects: Sixty six trauma patients admitted through the Accident and Emergency Unit from January 2000 to December 2004.
Results: Sixty six traumatised patient limbs were primarily amputated during the study period.
The male: female ratio was 3.7:1 and means age was 28.6 years ±16.6(range: 4-7lyears). 80.3% of the patients were below forty years. All the patients had a single limb amputation. The mean MESS score was 9.4 ± 1.3 (range: 7.0-12.0). The main predictive factors in trauma at the emergency unit for primary amputation include age, sex , occupation, limb ischaemia, gangrene, severe open fracture, source or nature of injury, presence of shock, delay in hospital presentation, and MESS.
Conclusion: Immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. Identified predictive factors for primary amputation will reduce trauma associated morbidity and mortality.
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