Functional outcome of bilateral limb threatening: Lower extremity injuries at two years postinjury

Joel J. Smith; Julie Agel; Mark F. Swiontkowski; Renan Castillo; Ellen MacKenzie; James F. Kellam; Michael J. Bosse; Andrew R. Burgess; Lawrence X. Webb; Roy W. Sanders; Alan L. Jones; Mark P. McAndrew; Brendan M. Patterson; Melissa L. McCarthy; Jennifer Avery; Denise Bailey; Wendall Bryan; Debbie Bullard; Carla Carpenter; Elizabeth Chaparro; Kate Corbin; Denise Darnell; Stephanie Dickason; Thomas DiPasquale; Betty Harkin; Michael Harrington; Dolfi Herscovici; Amy Holdren; Linda Howard; Sarah Hutchings; Marie Johnson; Melissa Jurewicz; Donna Lampke; Karen Lee; Marianne Mars; Maxine MendozaWelch; J. Wayne Meredith; Nan Morris; Karen Murdock; Andrew Pollak; Par Radey; Sandy Shelton; Sherry Simpson; Steven Sims; Douglas Smith; Adam Star; Celia Wiegman; John Wilber; Stephanie Williams; Philip Wolinsky; Mary Woodman; Michele Zimmerman

doi:10.1097/01.bot.0000151813.10046.e4

Functional outcome of bilateral limb threatening: Lower extremity injuries at two years postinjury

Joel J. Smith, Julie Agel, Mark F. Swiontkowski, Renan Castillo, Ellen MacKenzie, James F. Kellam, Michael J. Bosse, Andrew R. Burgess, Lawrence X. Webb, Roy W. Sanders, Alan L. Jones, Mark P. McAndrew, Brendan M. Patterson, Melissa L. McCarthy, Jennifer Avery, Denise Bailey, Wendall Bryan, Debbie Bullard, Carla Carpenter, Elizabeth ChaparroKate Corbin, Denise Darnell, Stephanie Dickason, Thomas DiPasquale, Betty Harkin, Michael Harrington, Dolfi Herscovici, Amy Holdren, Linda Howard, Sarah Hutchings, Marie Johnson, Melissa Jurewicz, Donna Lampke, Karen Lee, Marianne Mars, Maxine MendozaWelch, J. Wayne Meredith, Nan Morris, Karen Murdock, Andrew Pollak, Par Radey, Sandy Shelton, Sherry Simpson, Steven Sims, Douglas Smith, Adam Star, Celia Wiegman, John Wilber, Stephanie Williams, Philip Wolinsky, Mary Woodman, Michele Zimmerman

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

Objectives: To describe the functional outcome of bilateral limb-threatening injuries at 2 years postinjury and to evaluate whether a different decision-making process should be used for these patients as opposed to patients with unilateral limb-threatening injury. Design/Setting/Patients: This study population of 32 patients is a subset of 601 patients from a study of 8 level I trauma centers. The patients were prospectively followed through 24 months. Main Outcome Measurements: The principle outcome measure at 2 years was the Sickness Impact Profile, designed to measure physical and psychosocial dimensions. Results: The overall Sickness Impact Profile scores at 2 years demonstrate that all 3 bilateral injury groups (bilateral salvage [n = 14], unilateral salvage/amputation [n = 8], and bilateral amputation [n = 10]) were severely disabled (Sickness Impact Profile > 10). The bilateral salvage group had the most dramatic improvement over the 24 months. The 2-year physical subscale Sickness Impact Profile data showed a similar trend. At the 2-year assessment, the bilateral amputation group was recording greater disability (Sickness Impact Profile = 16.3) compared to the bilateral salvage and unilateral amputation/salvage groups (Sickness Impact Profile = 8.5 and 12.6, respectively). The overall Psychosocial Dimension, which started off worst in the bilateral salvage group, ended up similar in all 3 groups (8 to 9). The percent of patients who returned to work was 66.7% in the unilateral salvage /amputation group versus 21.4 and 16% in the bilateral salvage and amputation groups, respectively. Conclusions: The results indicate that treatment judgments should be based upon the results derived from the analysis of the larger unilateral limb cohort data. Patients with severe, bilateral lower extremity injuries should be counseled that regardless of treatment combinations, the function of each limb is similar at 24 months. The unilateral amputation/salvage group had a greater probability of going back to work. This is the major identifiable benefit to under-going salvage versus amputation.

Original language	English (US)
Pages (from-to)	249-253
Number of pages	5
Journal	Journal of orthopaedic trauma
Volume	19
Issue number	4
DOIs	https://doi.org/10.1097/01.bot.0000151813.10046.e4
State	Published - Apr 2005

Keywords

Bilateral injury
Lower extremity trauma
Sickness impact profile

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine

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10.1097/01.bot.0000151813.10046.e4

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Smith, J. J., Agel, J., Swiontkowski, M. F., Castillo, R., MacKenzie, E., Kellam, J. F., Bosse, M. J., Burgess, A. R., Webb, L. X., Sanders, R. W., Jones, A. L., McAndrew, M. P., Patterson, B. M., McCarthy, M. L., Avery, J., Bailey, D., Bryan, W., Bullard, D., Carpenter, C., ... Zimmerman, M. (2005). Functional outcome of bilateral limb threatening: Lower extremity injuries at two years postinjury. Journal of orthopaedic trauma, 19(4), 249-253. https://doi.org/10.1097/01.bot.0000151813.10046.e4

Smith, JJ, Agel, J, Swiontkowski, MF, Castillo, R, MacKenzie, E, Kellam, JF, Bosse, MJ, Burgess, AR, Webb, LX, Sanders, RW, Jones, AL, McAndrew, MP, Patterson, BM, McCarthy, ML, Avery, J, Bailey, D, Bryan, W, Bullard, D, Carpenter, C, Chaparro, E, Corbin, K, Darnell, D, Dickason, S, DiPasquale, T, Harkin, B, Harrington, M, Herscovici, D, Holdren, A, Howard, L, Hutchings, S, Johnson, M, Jurewicz, M, Lampke, D, Lee, K, Mars, M, MendozaWelch, M, Meredith, JW, Morris, N, Murdock, K, Pollak, A, Radey, P, Shelton, S, Simpson, S, Sims, S, Smith, D, Star, A, Wiegman, C, Wilber, J, Williams, S, Wolinsky, P, Woodman, M & Zimmerman, M 2005, 'Functional outcome of bilateral limb threatening: Lower extremity injuries at two years postinjury', Journal of orthopaedic trauma, vol. 19, no. 4, pp. 249-253. https://doi.org/10.1097/01.bot.0000151813.10046.e4

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title = "Functional outcome of bilateral limb threatening: Lower extremity injuries at two years postinjury",

abstract = "Objectives: To describe the functional outcome of bilateral limb-threatening injuries at 2 years postinjury and to evaluate whether a different decision-making process should be used for these patients as opposed to patients with unilateral limb-threatening injury. Design/Setting/Patients: This study population of 32 patients is a subset of 601 patients from a study of 8 level I trauma centers. The patients were prospectively followed through 24 months. Main Outcome Measurements: The principle outcome measure at 2 years was the Sickness Impact Profile, designed to measure physical and psychosocial dimensions. Results: The overall Sickness Impact Profile scores at 2 years demonstrate that all 3 bilateral injury groups (bilateral salvage [n = 14], unilateral salvage/amputation [n = 8], and bilateral amputation [n = 10]) were severely disabled (Sickness Impact Profile > 10). The bilateral salvage group had the most dramatic improvement over the 24 months. The 2-year physical subscale Sickness Impact Profile data showed a similar trend. At the 2-year assessment, the bilateral amputation group was recording greater disability (Sickness Impact Profile = 16.3) compared to the bilateral salvage and unilateral amputation/salvage groups (Sickness Impact Profile = 8.5 and 12.6, respectively). The overall Psychosocial Dimension, which started off worst in the bilateral salvage group, ended up similar in all 3 groups (8 to 9). The percent of patients who returned to work was 66.7% in the unilateral salvage /amputation group versus 21.4 and 16% in the bilateral salvage and amputation groups, respectively. Conclusions: The results indicate that treatment judgments should be based upon the results derived from the analysis of the larger unilateral limb cohort data. Patients with severe, bilateral lower extremity injuries should be counseled that regardless of treatment combinations, the function of each limb is similar at 24 months. The unilateral amputation/salvage group had a greater probability of going back to work. This is the major identifiable benefit to under-going salvage versus amputation.",

keywords = "Bilateral injury, Lower extremity trauma, Sickness impact profile",

author = "Smith, {Joel J.} and Julie Agel and Swiontkowski, {Mark F.} and Renan Castillo and Ellen MacKenzie and Kellam, {James F.} and Bosse, {Michael J.} and Burgess, {Andrew R.} and Webb, {Lawrence X.} and Sanders, {Roy W.} and Jones, {Alan L.} and McAndrew, {Mark P.} and Patterson, {Brendan M.} and McCarthy, {Melissa L.} and Jennifer Avery and Denise Bailey and Wendall Bryan and Debbie Bullard and Carla Carpenter and Elizabeth Chaparro and Kate Corbin and Denise Darnell and Stephanie Dickason and Thomas DiPasquale and Betty Harkin and Michael Harrington and Dolfi Herscovici and Amy Holdren and Linda Howard and Sarah Hutchings and Marie Johnson and Melissa Jurewicz and Donna Lampke and Karen Lee and Marianne Mars and Maxine MendozaWelch and Meredith, {J. Wayne} and Nan Morris and Karen Murdock and Andrew Pollak and Par Radey and Sandy Shelton and Sherry Simpson and Steven Sims and Douglas Smith and Adam Star and Celia Wiegman and John Wilber and Stephanie Williams and Philip Wolinsky and Mary Woodman and Michele Zimmerman",

year = "2005",

month = apr,

doi = "10.1097/01.bot.0000151813.10046.e4",

language = "English (US)",

volume = "19",

pages = "249--253",

journal = "Journal of orthopaedic trauma",

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T1 - Functional outcome of bilateral limb threatening

T2 - Lower extremity injuries at two years postinjury

AU - Smith, Joel J.

AU - Agel, Julie

AU - Swiontkowski, Mark F.

AU - Castillo, Renan

AU - MacKenzie, Ellen

AU - Kellam, James F.

AU - Bosse, Michael J.

AU - Burgess, Andrew R.

AU - Webb, Lawrence X.

AU - Sanders, Roy W.

AU - Jones, Alan L.

AU - McAndrew, Mark P.

AU - Patterson, Brendan M.

AU - McCarthy, Melissa L.

AU - Avery, Jennifer

AU - Bailey, Denise

AU - Bryan, Wendall

AU - Bullard, Debbie

AU - Carpenter, Carla

AU - Chaparro, Elizabeth

AU - Corbin, Kate

AU - Darnell, Denise

AU - Dickason, Stephanie

AU - DiPasquale, Thomas

AU - Harkin, Betty

AU - Harrington, Michael

AU - Herscovici, Dolfi

AU - Holdren, Amy

AU - Howard, Linda

AU - Hutchings, Sarah

AU - Johnson, Marie

AU - Jurewicz, Melissa

AU - Lampke, Donna

AU - Lee, Karen

AU - Mars, Marianne

AU - MendozaWelch, Maxine

AU - Meredith, J. Wayne

AU - Morris, Nan

AU - Murdock, Karen

AU - Pollak, Andrew

AU - Radey, Par

AU - Shelton, Sandy

AU - Simpson, Sherry

AU - Sims, Steven

AU - Smith, Douglas

AU - Star, Adam

AU - Wiegman, Celia

AU - Wilber, John

AU - Williams, Stephanie

AU - Wolinsky, Philip

AU - Woodman, Mary

AU - Zimmerman, Michele

PY - 2005/4

Y1 - 2005/4

N2 - Objectives: To describe the functional outcome of bilateral limb-threatening injuries at 2 years postinjury and to evaluate whether a different decision-making process should be used for these patients as opposed to patients with unilateral limb-threatening injury. Design/Setting/Patients: This study population of 32 patients is a subset of 601 patients from a study of 8 level I trauma centers. The patients were prospectively followed through 24 months. Main Outcome Measurements: The principle outcome measure at 2 years was the Sickness Impact Profile, designed to measure physical and psychosocial dimensions. Results: The overall Sickness Impact Profile scores at 2 years demonstrate that all 3 bilateral injury groups (bilateral salvage [n = 14], unilateral salvage/amputation [n = 8], and bilateral amputation [n = 10]) were severely disabled (Sickness Impact Profile > 10). The bilateral salvage group had the most dramatic improvement over the 24 months. The 2-year physical subscale Sickness Impact Profile data showed a similar trend. At the 2-year assessment, the bilateral amputation group was recording greater disability (Sickness Impact Profile = 16.3) compared to the bilateral salvage and unilateral amputation/salvage groups (Sickness Impact Profile = 8.5 and 12.6, respectively). The overall Psychosocial Dimension, which started off worst in the bilateral salvage group, ended up similar in all 3 groups (8 to 9). The percent of patients who returned to work was 66.7% in the unilateral salvage /amputation group versus 21.4 and 16% in the bilateral salvage and amputation groups, respectively. Conclusions: The results indicate that treatment judgments should be based upon the results derived from the analysis of the larger unilateral limb cohort data. Patients with severe, bilateral lower extremity injuries should be counseled that regardless of treatment combinations, the function of each limb is similar at 24 months. The unilateral amputation/salvage group had a greater probability of going back to work. This is the major identifiable benefit to under-going salvage versus amputation.

AB - Objectives: To describe the functional outcome of bilateral limb-threatening injuries at 2 years postinjury and to evaluate whether a different decision-making process should be used for these patients as opposed to patients with unilateral limb-threatening injury. Design/Setting/Patients: This study population of 32 patients is a subset of 601 patients from a study of 8 level I trauma centers. The patients were prospectively followed through 24 months. Main Outcome Measurements: The principle outcome measure at 2 years was the Sickness Impact Profile, designed to measure physical and psychosocial dimensions. Results: The overall Sickness Impact Profile scores at 2 years demonstrate that all 3 bilateral injury groups (bilateral salvage [n = 14], unilateral salvage/amputation [n = 8], and bilateral amputation [n = 10]) were severely disabled (Sickness Impact Profile > 10). The bilateral salvage group had the most dramatic improvement over the 24 months. The 2-year physical subscale Sickness Impact Profile data showed a similar trend. At the 2-year assessment, the bilateral amputation group was recording greater disability (Sickness Impact Profile = 16.3) compared to the bilateral salvage and unilateral amputation/salvage groups (Sickness Impact Profile = 8.5 and 12.6, respectively). The overall Psychosocial Dimension, which started off worst in the bilateral salvage group, ended up similar in all 3 groups (8 to 9). The percent of patients who returned to work was 66.7% in the unilateral salvage /amputation group versus 21.4 and 16% in the bilateral salvage and amputation groups, respectively. Conclusions: The results indicate that treatment judgments should be based upon the results derived from the analysis of the larger unilateral limb cohort data. Patients with severe, bilateral lower extremity injuries should be counseled that regardless of treatment combinations, the function of each limb is similar at 24 months. The unilateral amputation/salvage group had a greater probability of going back to work. This is the major identifiable benefit to under-going salvage versus amputation.

KW - Bilateral injury

KW - Lower extremity trauma

KW - Sickness impact profile

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Functional outcome of bilateral limb threatening: Lower extremity injuries at two years postinjury

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