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Conserver ou amputer une fracture ouverte de jambe avec délabrement en première intention ? Evaluation fonctionnelle et de la qualité de la vie

Severe lower-limb trauma is a major event in a patient's life, and
treatment is a challenge that has not been sufficiently studied.
The main objective of the present study was to assess the difference in disability between
amputees and patients who kept their leg after severe open lower-limb fracture.
HYPOTHESIS: The study hypothesis was that amputation allows better functional
recovery and quality of life, in the same time-frame. METHODS: All
male and female patients aged over 18 years admitted to one of the trauma centers
of Marseille (France) for major lower-limb trauma with Gustilo IIIb or IIIc
fracture were included. Minimum follow-up was 2 years. Two groups were
distinguished according to primary treatment: lower-limb salvage, or amputation.
Rates of infection and of surgical revision, hospital stay, functional parameters
(walking distance, standing, use of canes, running, jumping, driving, and
physical and occupational activity) and quality of life (MOS SF-36 score) were
compared between groups. RESULTS: The conservative treatment group comprised 27
patients, and the amputation group 24. Rates of infection and of surgical
revision and hospital stay were significantly lower in the amputation group
(P<0.02). All functional parameters (except return to work) and overall quality
of life were significantly better in the amputation group.
There was no
significant inter-group difference in MOS mental score. CONCLUSION: In severe
lower-limb trauma, amputation seems to give better functional and quality-of-life
results. It did not, however, improve return to work, and was not better accepted
psychologically than long and complex conservative management.
LEVEL OF EVIDENCE:
IV, retrospective study.
CI - Copyright (c) 2018 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS

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