Skip to main content
SpringerLink
Log in

Outcome and Management of Primary Amputations, Subtotal Amputation Injuries, and Severe Open Fractures with Nerve Injuries

  • Chapter
The Poly-Traumatized Patient with Fractures

  • 1588 Accesses

Abstract

Patients with severe lower-extremity trauma present multiple challenges to surgeons, physiatrists, rehabilitation specialists, and family members. Often there is considerable debate surrounding limb salvage or to proceed with early amputation. Prior to the LEAP study (Lower Extremity Assessment Project), high-level evidence assisting the clinician in this decision was lacking. This chapter details the findings of the LEAP study and other studies examining combat-related injuries and provides the surgeon and other members of the treatment team valuable information and guidance in the management and counseling of the trauma patient with severe limb-threatening trauma.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Andersson G, American Academy of Orthopaedic Surgeons. United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), Third Edition, 2014. Rosemont, IL. Available at http://www.boneandjointburden.org. Accessed on 15 July 2015.

  2. MacKenzie EJ, Jones AS, Bosse MJ, Castillo RC, Pollak AN, Webb LX, et al. Health-care costs associated with amputation or reconstruction of a limb-threatening injury. J Bone Joint Surg Am. 2007;89(8):1685–92.

    PubMed  Google Scholar 

  3. Wright JG. A practical guide to assigning levels of evidence. J Bone Joint Surg Am. 2007;89(5):1128–30.

    PubMed  Google Scholar 

  4. Dillingham TR, Pezzin LE, MacKenzie EJ. Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputee patients: an epidemiologic study. Arch Phys Med Rehabil. 1998;79(3):279–87.

    Article  CAS  PubMed  Google Scholar 

  5. Dillingham TR, Pezzin LE, MacKenzie EJ. Limb amputation and limb deficiency: epidemiology and recent trends in the United States. South Med J. 2002;95(8):875–83.

    PubMed  Google Scholar 

  6. Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg. 1986;78(3):285–92.

    Article  CAS  PubMed  Google Scholar 

  7. Francel TJ, Vander Kolk CA, Hoopes JE, Manson PN, Yaremchuk MJ. Microvascular soft-tissue transplantation for reconstruction of acute open tibial fractures: timing of coverage and long-term functional results. Plast Reconstr Surg. 1992;89(3):478–87; discussion 88–9.

    Article  CAS  PubMed  Google Scholar 

  8. Caudle RJ, Stern PJ. Severe open fractures of the tibia. J Bone Joint Surg Am. 1987;69(6):801–7.

    Article  CAS  PubMed  Google Scholar 

  9. Anglen J, Kyle RF, Marsh JL, Virkus WW, Watters III WC, Keith MW, et al. Locking plates for extremity fractures. J Am Acad Orthop Surg. 2009;17(7):465–72.

    Article  PubMed  Google Scholar 

  10. Collinge CA, Sanders RW. Percutaneous plating in the lower extremity. J Am Acad Orthop Surg. 2000;8(4):211–6.

    Article  CAS  PubMed  Google Scholar 

  11. Haidukewych GJ. Innovations in locking plate technology. J Am Acad Orthop Surg. 2004;12(4):205–12.

    Article  PubMed  Google Scholar 

  12. Haidukewych GJ, Ricci W. Locked plating in orthopaedic trauma: a clinical update. J Am Acad Orthop Surg. 2008;16(6):347–55.

    Article  PubMed  Google Scholar 

  13. Gorman PW, Barnes CL, Fischer TJ, McAndrew MP, Moore MM. Soft-tissue reconstruction in severe lower extremity trauma. A review. Clin Orthop Relat Res. 1989;243:57–64.

    Google Scholar 

  14. Lange RH. Limb reconstruction versus amputation decision making in massive lower extremity trauma. Clin Orthop Relat Res. 1989;243:92–9.

    Google Scholar 

  15. Hansen Jr ST. The type-IIIC tibial fracture. Salvage or amputation. J Bone Joint Surg Am. 1987;69(6):799–800.

    Article  PubMed  Google Scholar 

  16. Smith DG, Castillo R, MacKenzie E, Bosse MJ, Group TLS. Functional outcomes of patients who have late amputation after trauma is significantly worse than for those who have early amputation. Orthopaedic trauma association 2003 annual meeting; 10/9/2003; Salt Lake City, UT2003.

    Google Scholar 

  17. Hansen Jr ST. Overview of the severely traumatized lower limb. Reconstruction versus amputation. Clin Orthop Relat Res. 1989;243:17–9.

    Google Scholar 

  18. Georgiadis GM, Behrens FF, Joyce MJ, Earle AS, Simmons AL. Open tibial fractures with severe soft-tissue loss. Limb salvage compared with below-the-knee amputation. J Bone Joint Surg Am. 1993;75(10):1431–41.

    Article  CAS  PubMed  Google Scholar 

  19. Francel TJ. Improving reemployment rates after limb salvage of acute severe tibial fractures by microvascular soft-tissue reconstruction. Plast Reconstr Surg. 1994;93(5):1028–34.

    Article  CAS  PubMed  Google Scholar 

  20. MacKenzie EJ, Bosse MJ, Pollak AN, Webb LX, Swiontkowski MF, Kellam JF, et al. Long-term persistence of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am. 2005;87(8):1801–9.

    PubMed  Google Scholar 

  21. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. An analysis of outcomes of reconstruction or amputation after leg-threatening injuries. N Engl J Med. 2002;347(24):1924–31.

    Article  PubMed  Google Scholar 

  22. MacKenzie EJ, Bosse MJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. Characterization of patients with high-energy lower extremity trauma. J Orthop Trauma. 2000;14(7):455–66.

    Article  CAS  PubMed  Google Scholar 

  23. Alexander RH, Proctor HJ, American College of Surgeons, Committee on Trauma. Advanced trauma life support program for physicians: ATLS. 5th ed. Chicago: American College of Surgeons; 1993.

    Google Scholar 

  24. Trauma ACoSCo. Advanced trauma life support for doctors ATLS: manuals for coordinators and faculty. 8th ed. Chicago: American College of Surgeons; 2008.

    Google Scholar 

  25. Trauma ACoSCo. Advanced trauma life support for doctors: student course manual. 6th ed. Chicago: American College of Surgeons; 1997.

    Google Scholar 

  26. Pinzur M. Amputations in trauma. In: Browner BD, Jupiter J, Levine A, Trafton P, Krettek C, editors. Skeletal trauma: basic science, management, and reconstruction, vol. 2. 4th ed. Philadelphia: Saunders/Elsevier; 2009. p. 2 v. xxv, 2882, I56 p.

    Google Scholar 

  27. MacKenzie EJ, Bosse MJ, Castillo RC, Smith DG, Webb LX, Kellam JF, et al. Functional outcomes following trauma-related lower-extremity amputation. J Bone Joint Surg Am. 2004;86-A(8):1636–45.

    Article  PubMed  Google Scholar 

  28. Pinzur MS, Smith DG, Daluga DJ, Osterman H. Selection of patients for through-the-knee amputation. J Bone Joint Surg Am. 1988;70(5):746–50.

    Article  CAS  PubMed  Google Scholar 

  29. Johansen K, Daines M, Howey T, Helfet D, Hansen Jr ST. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30(5):568–72; discussion 72–3.

    Article  CAS  PubMed  Google Scholar 

  30. Pinzur MS, Angelats J, Light TR, Izuierdo R, Pluth T. Functional outcome following traumatic upper limb amputation and prosthetic limb fitting. J Hand Surg Am. 1994;19(5):836–9.

    Article  CAS  PubMed  Google Scholar 

  31. Dagum AB, Best AK, Schemitsch EH, Mahoney JL, Mahomed MN, Blight KR. Salvage after severe lower-extremity trauma: are the outcomes worth the means? Plast Reconstr Surg. 1999;103(4):1212–20.

    Article  CAS  PubMed  Google Scholar 

  32. Russell WL, Sailors DM, Whittle TB, Fisher Jr DF, Burns RP. Limb salvage versus traumatic amputation. A decision based on a seven-part predictive index. Ann Surg. 1991;213(5):473–80; discussion 80–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Bonanni F, Rhodes M, Lucke JF. The futility of predictive scoring of mangled lower extremities. J Trauma. 1993;34(1):99–104.

    Article  CAS  PubMed  Google Scholar 

  34. Howe Jr HR, Poole Jr GV, Hansen KJ, Clark T, Plonk GW, Koman LA, et al. Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg. 1987;53(4):205–8.

    PubMed  Google Scholar 

  35. Lange RH, Bach AW, Hansen Jr ST, Johansen KH. Open tibial fractures with associated vascular injuries: prognosis for limb salvage. J Trauma. 1985;25(3):203–8.

    Article  CAS  PubMed  Google Scholar 

  36. Dougherty PJ. Long-term follow-up of unilateral transfemoral amputees from the Vietnam war. J Trauma. 2003;54(4):718–23.

    Article  PubMed  Google Scholar 

  37. Smith DG, Horn P, Malchow D, Boone DA, Reiber GE, Hansen Jr ST. Prosthetic history, prosthetic charges, and functional outcome of the isolated, traumatic below-knee amputee. J Trauma. 1995;38(1):44–7.

    Article  CAS  PubMed  Google Scholar 

  38. Lerner RK, Esterhai Jr JL, Polomano RC, Cheatle MD, Heppenstall RB. Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation. Clin Orthop Relat Res. 1993;295:28–36.

    Google Scholar 

  39. Lerner RK, Esterhai Jr JL, Polomono RC, Cheatle MC, Heppenstall RB, Brighton CT. Psychosocial, functional, and quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower extremity amputation. Arch Phys Med Rehabil. 1991;72(2):122–6.

    CAS  PubMed  Google Scholar 

  40. Bell JC, Wolf EJ, Schnall BL, Tis JE, Tis LL, Potter BK. Transfemoral amputations: the effect of residual limb length and orientation on gait analysis outcome measures. J Bone Joint Surg Am. 2013;95(5):408–14.

    Article  PubMed  Google Scholar 

  41. Dougherty PJ. Transtibial amputees from the Vietnam War. Twenty-eight-year follow-up. J Bone Joint Surg Am. 2001;83-A(3):383–9.

    Article  CAS  PubMed  Google Scholar 

  42. Bondurant FJ, Cotler HB, Buckle R, Miller-Crotchett P, Browner BD. The medical and economic impact of severely injured lower extremities. J Trauma. 1988;28(8):1270–3.

    Article  CAS  PubMed  Google Scholar 

  43. Dirschl DR, Dahners LE. The mangled extremity: when should it be amputated? J Am Acad Orthop Surg. 1996;4(4):182–90.

    Article  CAS  PubMed  Google Scholar 

  44. MacKenzie EJ, Bosse MJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma. 2002;52(4):641–9.

    PubMed  Google Scholar 

  45. Bosse MJ, MacKenzie EJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. A prospective evaluation of the clinical utility of the lower-extremity injury-severity scores. J Bone Joint Surg Am. 2001;83-A(1):3–14.

    Article  CAS  PubMed  Google Scholar 

  46. Durham RM, Mistry BM, Mazuski JE, Shapiro M, Jacobs D. Outcome and utility of scoring systems in the management of the mangled extremity. Am J Surg. 1996;172(5):569–73; discussion 73–4.

    Article  CAS  PubMed  Google Scholar 

  47. O'Sullivan ST, O'Sullivan M, Pasha N, O'Shaughnessy M, O'Connor TP. Is it possible to predict limb viability in complex Gustilo IIIB and IIIC tibial fractures? A comparison of two predictive indices. Injury. 1997;28(9–10):639–42.

    Article  PubMed  Google Scholar 

  48. Helfet DL, Howey T, Sanders R, Johansen K. Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score. Clin Orthop Relat Res. 1990;256:80–6.

    Google Scholar 

  49. McNamara MG, Heckman JD, Corley FG. Severe open fractures of the lower extremity: a retrospective evaluation of the Mangled Extremity Severity Score (MESS). J Orthop Trauma. 1994;8(2):81–7.

    Article  CAS  PubMed  Google Scholar 

  50. Tscherne H, Gotzen L. Fractures with soft tissue injuries. Berlin/New York: Springer; 1984. vi, 164 p. p.

    Book  Google Scholar 

  51. Rajasekaran S, Naresh Babu J, Dheenadhayalan J, Shetty AP, Sundararajan SR, Kumar M, et al. A score for predicting salvage and outcome in Gustilo type-IIIA and type-IIIB open tibial fractures. J Bone Joint Surg Br. 2006;88(10):1351–60.

    Article  CAS  PubMed  Google Scholar 

  52. Lin CH, Wei FC, Levin LS, Su JI, Yeh WL. The functional outcome of lower-extremity fractures with vascular injury. J Trauma. 1997;43(3):480–5.

    Article  CAS  PubMed  Google Scholar 

  53. Ly TV, Travison TG, Castillo RC, Bosse MJ, MacKenzie EJ. Ability of lower-extremity injury severity scores to predict functional outcome after limb salvage. J Bone Joint Surg Am. 2008;90(8):1738–43.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The sickness impact profile: development and final revision of a health status measure. Med Care. 1981;19(8):787–805.

    Article  CAS  PubMed  Google Scholar 

  55. Bergner M, Bobbitt RA, Kressel S, Pollard WE, Gilson BS, Morris JR. The sickness impact profile: conceptual formulation and methodology for the development of a health status measure. Int J Health Serv. 1976;6(3):393–415.

    Article  CAS  PubMed  Google Scholar 

  56. de Bruin AF, de Witte LP, Stevens F, Diederiks JP. Sickness impact profile: the state of the art of a generic functional status measure. Soc Sci Med. 1992;35(8):1003–14.

    Article  PubMed  Google Scholar 

  57. Berkman L, Glass T. Social integration, social networks, social support, and health. In: Berkman L, Kawachi I, editors. Social epidemiology. New York: Oxford University Press; 2000.

    Google Scholar 

  58. MacKenzie EJ, Morris Jr JA, Jurkovich GJ, Yasui Y, Cushing BM, Burgess AR, et al. Return to work following injury: the role of economic, social, and job-related factors. Am J Public Health. 1998;88(11):1630–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. MacKenzie EJ, Bosse MJ. Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP). J Am Acad Orthop Surg. 2006;14(10 Spec No):S205–10.

    Article  PubMed  Google Scholar 

  60. O'Toole RV, Castillo RC, Pollak AN, MacKenzie EJ, Bosse MJ. Surgeons and their patients disagree regarding cosmetic and overall outcomes after surgery for high-energy lower extremity trauma. J Orthop Trauma. 2009;23(10):716–23.

    Article  PubMed  Google Scholar 

  61. O'Toole RV, Castillo RC, Pollak AN, MacKenzie EJ, Bosse MJ. Determinants of patient satisfaction after severe lower-extremity injuries. J Bone Joint Surg Am. 2008;90(6):1206–11.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Castillo RC, Bosse MJ, MacKenzie EJ, Patterson BM. Impact of smoking on fracture healing and risk of complications in limb-threatening open tibia fractures. J Orthop Trauma. 2005;19(3):151–7.

    Article  PubMed  Google Scholar 

  63. Archer KR, MacKenzie EJ, Bosse MJ, Pollak AN, Riley 3rd LH. Factors associated with surgeon referral for physical therapy in patients with traumatic lower-extremity injury: results of a national survey of orthopedic trauma surgeons. Phys Ther. 2009;89(9):893–905.

    Article  PubMed  Google Scholar 

  64. Archer KR, Castillo RC, Mackenzie EJ, Bosse MJ. Gait symmetry and walking speed analysis following lower-extremity trauma. Phys Ther. 2006;86(12):1630–40.

    Article  PubMed  Google Scholar 

  65. Castillo RC, MacKenzie EJ, Archer KR, Bosse MJ, Webb LX. Evidence of beneficial effect of physical therapy after lower-extremity trauma. Arch Phys Med Rehabil. 2008;89(10):1873–9.

    Article  PubMed  Google Scholar 

  66. Ellington JK, Bosse MJ, Castillo RC, MacKenzie EJ, Group LS. The mangled foot and ankle: results from a 2-year prospective study. J Orthop Trauma. 2013;27(1):43–8.

    Article  PubMed  Google Scholar 

  67. Lawrence SJ, Singhal M. Open hindfoot injuries. J Am Acad Orthop Surg. 2007;15(6):367–76.

    Article  PubMed  Google Scholar 

  68. Ramasamy A, Hill AM, Masouros S, Gibb I, Phillip R, Bull AM, et al. Outcomes of IED foot and ankle blast injuries. J Bone Joint Surg Am. 2013;95(5), e25.

    Article  PubMed  Google Scholar 

  69. Dickens JF, Kilcoyne KG, Kluk MW, Gordon WT, Shawen SB, Potter BK. Risk factors for infection and amputation following open, combat-related calcaneal fractures. J Bone Joint Surg Am. 2013;95(5), e24.

    Article  PubMed  Google Scholar 

  70. Harris AM, Althausen PL, Kellam J, Bosse MJ, Castillo R. Complications following limb-threatening lower extremity trauma. J Orthop Trauma. 2009;23(1):1–6.

    Article  PubMed  Google Scholar 

  71. Pollak AN, McCarthy ML, Burgess AR. Short-term wound complications after application of flaps for coverage of traumatic soft-tissue defects about the tibia. The Lower Extremity Assessment Project (LEAP) Study Group. J Bone Joint Surg Am. 2000;82-A(12):1681–91.

    Article  CAS  PubMed  Google Scholar 

  72. Quon DL, Dudek NL, Marks M, Boutet M, Varpio L. A qualitative study of factors influencing the decision to have an elective amputation. J Bone Joint Surg Am. 2011;93(22):2087–92.

    Article  PubMed  Google Scholar 

  73. Crichlow RJ, Andres PL, Morrison SM, Haley SM, Vrahas MS. Depression in orthopaedic trauma patients. Prevalence and severity. J Bone Joint Surg Am. 2006;88(9):1927–33.

    PubMed  Google Scholar 

  74. Singh G, Harkema JM, Mayberry AJ, Chaudry IH. Severe depression of gut absorptive capacity in patients following trauma or sepsis. J Trauma. 1994;36(6):803–8; discussion 8–9.

    Article  CAS  PubMed  Google Scholar 

  75. McCarthy ML, MacKenzie EJ, Edwin D, Bosse MJ, Castillo RC, Starr A. Psychological distress associated with severe lower-limb injury. J Bone Joint Surg Am. 2003;85-A(9):1689–97.

    Article  PubMed  Google Scholar 

  76. Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983;13(3):595–605.

    Article  CAS  PubMed  Google Scholar 

  77. Derogatis LP. BSI: brief symptom inventory. 3rd ed. Minneapolis: National Computer Systems; 1993.

    Google Scholar 

  78. Castillo RC, MacKenzie EJ, Wegener ST, Bosse MJ. Prevalence of chronic pain seven years following limb threatening lower extremity trauma. Pain. 2006;124(3):321–9.

    Article  PubMed  Google Scholar 

  79. Wegener ST, Castillo RC, Haythornthwaite J, Mackenzie EJ, Bosse MJ, Group LS. Psychological distress mediates the effect of pain on function. Pain. 2011;152(6):1349–57.

    Article  PubMed  Google Scholar 

  80. Castillo RC, Wegener ST, Heins SE, Haythornthwaite JA, Mackenzie EJ, Bosse MJ, et al. Longitudinal relationships between anxiety, depression, and pain: results from a two-year cohort study of lower extremity trauma patients. Pain. 2013;154(12):2860–6.

    Article  PubMed  Google Scholar 

  81. Lusskin R, Battista A. Evaluation and therapy after injury to peripheral nerves. Foot Ankle. 1986;7(2):71–81.

    Article  CAS  PubMed  Google Scholar 

  82. Aldea PA, Shaw WW. Management of acute lower extremity nerve injuries. Foot Ankle. 1986;7(2):82–94.

    Article  CAS  PubMed  Google Scholar 

  83. Bateman JE. Trauma to nerves in limbs. Philadelphia: Saunders; 1962. p. 443.

    Google Scholar 

  84. Bosse MJ, McCarthy ML, Jones AL, Webb LX, Sims SH, Sanders RW, et al. The insensate foot following severe lower extremity trauma: an indication for amputation? J Bone Joint Surg Am. 2005;87(12):2601–8.

    PubMed  Google Scholar 

  85. Beltran MJ, Burns TC, Eckel TT, Potter BK, Wenke JC, Hsu JR, et al. Fate of combat nerve injury. J Orthop Trauma. 2012;26(11):e198–203.

    Article  PubMed  Google Scholar 

  86. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Egleston BL, Salkever DS, et al. The impact of trauma-center care on functional outcomes following major lower-limb trauma. J Bone Joint Surg Am. 2008;90(1):101–9.

    Article  PubMed  Google Scholar 

  87. Krettek C, Seekamp A, Kontopp H, Tscherne H. Hannover Fracture Scale '98 – re-evaluation and new perspectives of an established extremity salvage score. Injury. 2001;32(4):317–28.

    Article  CAS  PubMed  Google Scholar 

  88. Tscherne H, Oestern HJ. A new classification of soft-tissue damage in open and closed fractures (author’s transl). Unfallheilkunde. 1982;85(3):111–5.

    CAS  PubMed  Google Scholar 

  89. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453–8.

    Article  CAS  PubMed  Google Scholar 

  90. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742–6.

    Article  CAS  PubMed  Google Scholar 

  91. Winquist RA, Hansen Jr ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1984;66(4):529–39.

    Article  CAS  PubMed  Google Scholar 

  92. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop Relat Res. 1983;178:7–25.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopedic Trauma, Department of Orthopedic Surgery, Mayo Clinic, 200 1 St. SW, Rochester, MN, 55902, USA

    William W. Cross III

  2. Department of Orthopaedic Surgery, University of Minnesota, University of Minnesota Medical School, 2450 Riverside Ave. S. Suite R200, Minneapolis, MN, 55454, USA

    Marc F. Swiontkowski

Authors
  1. William W. Cross III
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc F. Swiontkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to William W. Cross III .

Editor information

Editors and Affiliations

  1. Department of Trauma, Hand, Plastic and Reconstructive Surgery, Aachen Medical Center, Aachen, Germany

    Hans-Christoph Pape

  2. Florida Orthopaedic Institute, Temple Terrace, Florida, USA

    Roy Sanders

  3. Orthopedic Medicine Specialists, Arlington, Texas, USA

    Joseph Borrelli, Jr.

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Cross, W.W., Swiontkowski, M.F. (2016). Outcome and Management of Primary Amputations, Subtotal Amputation Injuries, and Severe Open Fractures with Nerve Injuries. In: Pape, HC., Sanders, R., Borrelli, Jr., J. (eds) The Poly-Traumatized Patient with Fractures. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47212-5_22

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-47212-5_22

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-47211-8

  • Online ISBN: 978-3-662-47212-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation