Grenzen des Gliedmaßenerhalts bei III° offenen Unterschenkelfrakturen

In III B and III C open tibial fractures (according to Gustilo) it is extremely difficult to decide if an attempt should be taken to salvage the extremity or to perform an amputation. To standardize the criteria for amputation different salvage scores (PSI, MESS, NISSSA, HFS'98) have been published in recent years. However, large trials failed to show a high clinical value of those scoring systems. Salvage scores can therefore not be used as the single criterion to decide how to treat a mangled leg. In doubt, an attempt to salvage the extremity should be taken. Following this initial surgery a second look procedure after 24 to 48 hours is planed. After the consultation of other specialist the definite decision has to be made. For the salvage procedure the patient should be transferred to a level I trauma center. Patients seem to have a better clinical and social outcome after primary amputation (0 -7 days after trauma) compared to secondary amputation (2 - 6 weeks after trauma).