Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS)

Journal of Orthopaedic Trauma
M G McNamaraF G Corley


Recent reports using the Mangled Extremity Severity Score (MESS) suggest that a score of > or = 7 is 100% accurate in predicting the need for amputation of severely injured lower extremities. To further evaluate the value of the MESS in predicting amputation, specifically with respect to type IIIB and type IIIC (Gustilo and Anderson) open fractures of the tibia, we retrospectively evaluated 24 patients with these injuries. A significant difference (p = 0.001) between MESS values of 13 salvaged (6.36 +/- 0.35 SEM) and 11 amputated limbs (6.36 +/- 0.54 SEM) was found. A MESS value of > or = 4 was most sensitive (100%); a MESS value of > or = 7 was most specific, and a MESS value of > or = 7 was found to have a positive predictive value of 100%. Subsequently, we addressed recent criticisms of the MESS by including nerve injury in the scoring system and by separating soft-tissue and skeletal injury components of the MESS. We modified the MESS with a score called the NISSSA and applied it retrospectively to our cases. After careful statistical comparison we found both the MESS and NISSSA to be highly accurate (p < 0.005) in predicting amputation. The NISSSA was found to be more sensitive (81.8% versus 63.6%) and more specific (92.3 ...Continue Reading


Sep 1, 2005·Der Unfallchirurg·S RammeltH Zwipp
Mar 3, 2007·Der Unfallchirurg·Philipp KobbeH-C Pape
Mar 28, 2008·Der Unfallchirurg·Philipp KobbeH Reilmann
Jun 21, 2012·International Orthopaedics·Nikolaj Wolfson
Aug 28, 2012·International Orthopaedics·M BumbaširevićHenry D E Atkinson
Dec 17, 2010·Archives of Orthopaedic and Trauma Surgery·Ismail Bülent OzçelikSamet Vasfi Kuvat
Apr 17, 2002·The Journal of Trauma·Ellen J MacKenzieLEAP Study Group
Feb 13, 2003·The Journal of Trauma·Christoph Heitmann, L Scott Levin
Feb 4, 2010·Plastic and Reconstructive Surgery·Yee Siang Ong, L Scott Levin
Jan 14, 2011·Plastic and Reconstructive Surgery·Oren Z LermanL Scott Levin
Jun 12, 2009·The Journal of Trauma·K V BrownJ Clasper
Aug 5, 2008·The Journal of Bone and Joint Surgery. American Volume·Thuan V LyLEAP Study Group
Sep 16, 2009·Indian Journal of Orthopaedics·Rajasekaran Shanmuganathan
Nov 18, 2000·Journal of Orthopaedic Trauma·E J MacKenzieM L McCarthy
Jun 1, 2009·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Peep TalvingDemetrios Demetriades
Apr 14, 2016·Revista Brasileira De Ortopedia·Frederico Carlos Jaña NetoRobson Alves
Jan 23, 2016·BMC Musculoskeletal Disorders·Giuseppe Rosario SchiròGiulio Maccauro
Jan 8, 2013·Injury·Craig S Roberts, Erin L Adams
Oct 2, 2013·Journal of Children's Orthopaedics·David A StewartH Kerr Graham
Jun 14, 2012·Strategies in Trauma and Limb Reconstruction·Mark L PrasarnPeter Kloen
Aug 21, 2010·Chirurgie de la main·P TosBruno Battiston
Nov 15, 2011·Injury·Robert EberlMichael E Hoellwarth
Jun 8, 2012·International Wound Journal·Emanuele CignaMaria Giuseppina Onesti
Oct 7, 2009·Current Problems in Surgery·Robert M RushRandy J Kjorstad
Nov 19, 2005·Current Surgery·Lisa K Cannada, Carnell Cooper
Aug 1, 1996·The Surgical Clinics of North America·J E AlonsoB D Browner
Jun 28, 2005·Clinics in Podiatric Medicine and Surgery·George F Wallace
Nov 6, 2013·Journal of Biomedical Informatics·Barbaros YetWilliam Marsh
Feb 9, 2012·The Journal of Trauma and Acute Care Surgery·Thomas ScaleaDavid Feliciano
Feb 17, 2009·Journal of Orthopaedic Surgery and Research·Anastasios V KorompiliasPanayiotis N Soucacos
Feb 4, 2010·Journal of the American College of Surgeons·Nicholas T HaddockPierre B Saadeh
Feb 25, 2015·The Journal of Trauma and Acute Care Surgery·Sven MärdianPhilipp Schwabe
Jun 4, 2015·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·S RajasekaranK P Srikanth
Dec 29, 2016·The Journal of Trauma and Acute Care Surgery·Melissa N LojaAAST PROOVIT Study Group
Sep 23, 2017·Journal of Orthopaedic Trauma·Philip K McClureJanet D Conway
Dec 3, 2005·The Journal of Bone and Joint Surgery. American Volume·M J BosseLower Extremity Assessment Project (LEAP) Study Group
Apr 1, 1996·The Journal of Trauma·R PrêtreB Faidutti
Apr 25, 2018·JBJS Reviews·Erin A MillerStephen A Kennedy
Dec 19, 2018·The Journal of Bone and Joint Surgery. American Volume·Guang H Yim, Joseph T Hardwicke
May 9, 2007·Journal of Orthopaedic Trauma·Matthew H GriffithRoger F Widmann
Dec 22, 2010·Annals of Plastic Surgery·Charles A T Durrant, Simon P Mackey
Nov 20, 2014·The Open Orthopaedics Journal·Daniel J JordanSandip Hindocha
Nov 20, 2014·The Open Orthopaedics Journal·Daniel J JordanAli Juma
Nov 2, 2005·The Journal of Bone and Joint Surgery. British Volume·S TogawaS Ozeki
Oct 3, 2006·The Journal of Bone and Joint Surgery. British Volume·S RajasekaranS Rajasabapathy
Mar 22, 2012·The Journal of Bone and Joint Surgery. British Volume·K V BrownJ Clasper
Apr 4, 2014·Journal of Orthopaedic Trauma·Andrew J SheeanJoseph R Hsu
Jan 17, 2020·Plastic and Reconstructive Surgery. Global Open·Ira L SavetskyVishal D Thanik
Jan 11, 2011·The Journal of Trauma·Bernd KinnerChristina Roll
May 26, 2011·The Journal of Trauma·Jay J DoucetRaul Coimbra
Jan 1, 1996·Journal of Orthopaedic Trauma·R HertelR Ganz
Aug 24, 2019·PloS One·Yuko SuzukiTetsuya Takakuwa
May 22, 2010·Annals of the Royal College of Surgeons of England·W G P EardleyP J Parker
Feb 24, 2001·The Journal of Bone and Joint Surgery. American Volume·M J BosseJ K Cyril
Oct 1, 2015·Journal of Plastic Surgery and Hand Surgery·Shehab JabirNiri Niranjan
Oct 1, 2019·The Journal of Bone and Joint Surgery. American Volume·Shengdi LuYimin Chai
Dec 18, 2019·Archives of Orthopaedic and Trauma Surgery·Ruben DukanCharlie Bouthors
Jun 9, 2020·Archives of Orthopaedic and Trauma Surgery·Yong-Cheol YoonJong-Keon Oh
Mar 24, 1999·Plastic and Reconstructive Surgery·A B DagumK R Blight
Oct 3, 2020·Curēus·Mobeen K QureshiAhmad Khaled
Mar 3, 2005·Hospital Medicine·Stephen J Mannion
Jul 1, 1996·The Journal of the American Academy of Orthopaedic Surgeons·D R Dirschl, L E Dahners
Sep 22, 2018·Indian Journal of Orthopaedics·Akshat SharmaKumar Shashikant
Jul 27, 2010·Journal of Orthopaedic Trauma
Feb 28, 2021·Journal of Vascular Surgery·Leigh Ann O'BanionGregory A Magee
Jul 14, 2020·Annales de chirurgie plastique et esthétique·L PasquesooneE Guerre
Mar 27, 2021·Injury·M BumbaširevićA Lesić
Aug 6, 2020·Annales de chirurgie plastique et esthétique·P TaW Hu
Apr 19, 2021·Injury·Alexandru Valentin Georgescu, Bruno Battiston

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