The mangled extremity severity score (MESS) is a scoring system that can be applied to mangled extremities and help one determine which mangled limbs will . Mangled Extremity Severity Score (MESS). Introduction. used to predict necessity of amputation after lower extremity trauma. Variables. skeletal. fractures, soft tissue damage, vascular, nerve and tendon lesions. The Mangled Extremity Severity Score (MESS) is probably the most common scoring system.

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External fixator or cast was removed once the fracture was soundly united and adequate physiotherapy was advised. Prospectively applied MESS at two different hospitals consisting of eeverity separate patient populations on opposite sides of the country.

Trauma Scoring Systems – Trauma – Orthobullets

Do you think the traditional cut-off ecore 7 for limb viability should be adjusted as a result? Please fill out required fields. Journal List Indian J Orthop v.

Using a MESS cut-off of 7, the authors looked at outcomes of limbs in patients. Failed attempts at limb salvage result in prolonged hospitalization including multiple surgical procedures, pain and psychological trauma, as well as economic hardship to the patient.

What influence do you think more recent advances in surgical techniques and technology have had on the performance of the MESS? Both the magnled and surgeon must anticipate multiple subsequent operative procedures, a long-term commitment to rehabilitation and a high probability of significant sequelae and functional limitations as an end result in these serious high injuries. The ideal situation is one which allows identification of those patients who will benefit from early and aggressive attempts at limb salvage and those for whom primary amputation is extremlty correct choice.


I do not believe MESS should be considered dependable, and therefore utilized for decision-making, in kids, in upper extremity trauma or to predict longterm functional outcomes.

Mangled Extremity Severity Score (MESS)

Low energy stab, gunshot, simple fracture. Open in a manglfd window. Massive lower extremity trauma, in particular open tibial fractures with associated vascular injuries, presents immediate and complex decision-making challenges between a limb salvage attempt and primary amputation. A extrrmity, multi-center, prospective study comparing the utility of several lower extremity injury-severity scores, including MESS was published in Bondurant et al from Houstonand led to a retrospective analysis of such patients to discern whether objective clinical and demographic data available early in such patients’ course might predict the likelihood of success vs.

In the prospective study 4. Once adequate soft tissue coverage had been obtained, patient was discharged and followed up at regular intervals of mangked weeks for progression of fracture healing.

Cases were selected as per the following inclusion criteria:. The second look debridement under anesthesia was undertaken 48 to 72 hrs following the injury.

Johansen suggests, upper extremities are profoundly more important than lower extremities and prosthesis much more primitive, so nearly every effort at salvage should be attempted. Adequate physiotherapy was carried out depending upon the circumstances. This is a very important question. In the prospective extgemity all the attempted salvage patients were followed up for a minimum period of six months.

Radiographs of the mangled extremity were taken. This salvage protocol was abandoned if the general condition of the patient deteriorated or once the severe infection of injured limb was observed or renal failure set in making amputation inevitable.

Trauma Scoring Systems

Out of a total of 61 injured lower limbs, 11 limbs Clin Orthop Relat Res. S, Sewagram -WardhaIndia. Serial wound cultures were done and appropriate antibiotics were given.


Blatchford Score Assess sevdrity intervention scorw required for acute upper GI bleeding. Subcategory mangked ‘Diagnosis’ designed to be very sensitive Rule Out. They concluded that MESS is not sufficiently precise to allow the decision regarding deverity to be made at the initial operation.

Badole, Department of Orthopedics and Traumatology, M. This article has been cited by other articles in PMC. PCI and Cardiac Surgery. There was a significant difference in the mean Jangled scores in the prospective study, 4. Mangled extremity severity score 4. There was a significant difference in the mean scores for salvaged and amputated limbs.

Score taken at hospital admission. The occurrence of just one of two absolute indications complete posterior tibial nerve disruption in adults; crush injuries with longer than six hours of warm ischemia time warrants primary amputation, while at least two of three relative indications serious associated polytrauma, severe ipsilateral foot trauma or projected long course to full recovery must be present to reach that decision.

How important is this topic for clinical practice? In an attempt to identify those severely injured lower limbs, which could be successfully salvaged and those, which should proceed to primary amputation, a number of predictive indices were devised.

Forrest Classification Estimate risk of re-bleeding post-endoscopy for upper GI bleeding. Table 1 Mangled extremity severity score 4. While the evolution of sophisticated microsurgical reconstruction technique has created the possibility of successful limb salvage in even the most extreme cases, it has become painfully obvious that the technical possibilities are double-edged swords.