MESS Scale for Combat Limb Injury: Amputation or Salvage?
ARTICLE PDF (Українська)


combat injury

How to Cite

Liabakh, A., Derkach, R., & Kostogryz, O. (2022). MESS Scale for Combat Limb Injury: Amputation or Salvage?. TERRA ORTHOPAEDICA, (3(114), 15-20.


Summary. Combat injury of the limbs is characterized by multilevel open combined tissue damages, the severity of which in some cases makes it impossible the salvage tactics.

Objective: based on the analysis of literature, to investigate the possibility of using MESS (the mangled extremity severity score - assessment of the severity of a broken limb) when establishing indications for early amputation of a severely injured limb due to a combat trauma.

Materials and Methods. A literature search was conducted on the PubMed database according to the established criteria. Data were taken from the selected sources: the number of amputation/save cases and the weighted average MESS amputation/save value. A weighted average MESS with a 95% confidence interval (CI) and a coefficient of variation were calculated.

Results. A total of 189 sources according to the established criteria were identified for the period 1990-2021, in which MESS was applied; 7 sources were selected for analysis. The generalizing value (weighted average) for MESS for amputations was 7.3; 95% CI (6.27-8.33); the coefficient of variation was 4.1. While preserving the limb, the calculations showed a MESS value of 4.9; 95% CI (4.49-5.31); the coefficient of variation was 8.4.

Conclusions. The use of the MESS makes it possible to assess the condition of the injured limb; the value of 7 or above is a reliable predictor for amputation.
ARTICLE PDF (Українська)


Gregory RT, Gould RJ, Peclet M, Wagner JS, Gilbert DA, Wheeler JR et al. The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity. J Trauma. 1985;25(12):1147-50. PMID: 3934398.

Howe HR Jr, Poole GV Jr, Hansen KJ, Clark T, Plonk GW, Koman LA, Pennell TC. Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg. 1987;53:205-8. PMID: 3579025.

Johansen K, Daines M, Howey T, Helfet D, Hansen ST Jr. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30(5):568-73. DOI: 10.1097/00005373-199005000-00007.

Russell WL, Sailors DM, Whittle TB, Fisher DF Jr, Burns RP. Limb salvage versus traumatic amputation.A decision based on a seven-part predictive index. AnnSurg. 1991;213(5):473-81. DOI: 10.1097/00000658-199105000-00013.

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. DOI: 10.1097/00005131-199404000-00001.

Krettek C, Seekamp A, Kontopp H, Tscherne H. Hannover Fracture Scale 98 – reevaluation and new perspectives of an established extremity salvage score. Injury. 2001;32(4):317-28. DOI: 10.1016/s0020-1383(00)00201-1.

Shanmuganathan R. The utility of scores in the decision to salvage or amputation in severely injured limbs. Indian J Orthop. 2008;42(4):368-76. DOI: 10.4103/0019-5413.43371.

Karakus A, Kuvandik G, Atalay E. Evaluation of extremity injuries presented to emergency department. Arch Iran Med. 2017;20(10):646-648. PMID: 29137466.

Sharrock AE, Tai N, Perkins Z, White JM, Remick KN, Rickard RF, Rasmussen TE. Management and outcome of 597 wartime penetrating lower extremity arterial injuries from an international military cohort. J Vasc Surg. 2019;70(1):224-232. DOI: 10.1016/j.jvs.2018.11.024.

Rush RM, Kjorstad R, Starnes BW, Arrington E, Devine JD, Andersen CA. Application of the Mangled Extremity Severity Score in a combat setting. Mil Med. 2007;172(7):777-81. DOI: 10.7205/milmed.172.7.777.

Brown KV, Ramasamy A, McLeod J, Stapley S, Clasper JC. Predicting the need for early amputation in ballistic mangled extremity injuries. J Trauma. 2009;66(4 Suppl):S93-7; discussion S97-8. DOI: 10.1097/TA.0b013e31819cdcb0.

Gifford SM, Aidinian G, Clouse D, Fox CJ, Porras CA, Jones WT, Zarzabal LA, Michalek JE, Propper BW, Burkhardt GE, Rasmussen TE. From the southern association for vascular surgery effect of temporary shunting on extremity vascular injury: an outcome analysis from the global war on terror vascular injury initiative. J Vasc Surg. 2009;50(3):549-55. DOI: 10.1016/j.jvs.2009.03.051.

Doucet JJ, Galarneau MR, Potenza BM, Bansal V, Lee JG, Schwartz AK et al. Combat versus civilian open tibia fractures: the effect of blast mechanism on limb salvage. J Trauma. 2011;70(5):1241-7. DOI: 10.1097/TA.0b013e3182095b52.

Sheean AJ, Krueger CA, Napierala MA, Stinner DJ, Hsu JR, Skeletal Trauma and Research Consortium (STReC). Evaluation of the mangled extremity severity score in combat-related type III open tibia fracture. J Orthop Trauma. 2014;28(9):523-6. DOI: 10.1097/BOT.0000000000000054.

Ege T, Unlu A, Tas H, Bek D, Turkan S, Cetinkaya A. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries. Indian J Orthop. 2015;49(6):656-60. DOI: 10.4103/0019-5413.168759.

Schechtman DW, Walters TJ, Kauvar DS. Utility of the Mangled Extremity Severity Score in predicting amputation in military lower extremity arterial injury. Ann Vasc Surg. 2021;70:95-100. DOI: 10.1016/j.avsg.2020.08.095.

Connolly M, Ibrahim ZR, Johnson ON 3rd. Changing paradigms in lower extremity reconstruction in war-related injuries. Mil Med Res. 2016;31;3:9. DOI: 10.1186/s40779-016-0080-7.

You DZ, Schneider PS. Surgical timing for open fractures: Middle of the night or the light of day, which fractures, what time? OTA Int. 2020;23:3(1):e067. DOI: 10.1097/OI9.0000000000000067.

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(1):3-14. DOI: 10.2106/00004623-200101000-00002.

Fodor L, Sobec R, Sita-Alb L, Fodor M, Ciuce C. Mangled lower extremity: can we trust the amputation scores? Int J Burns Trauma. 2012;2(1):51-8. PMID: 22928167.

Kumar MK, Badole C, Patond K. Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs. Indian J Orthop. 2007;41(3):183-7. DOI: 10.4103/0019-5413.33679.

Ly TV, Travison TG, Castillo RC, Bosse MJ, MacKenzie EJ, LEAP Study Group. Ability of lower-extremity injury severity scores to predict functional outcome after limb salvage. J Bone Joint Surg Am. 2008;90(8):1738-43. DOI: 10.2106/JBJS.G.00136.

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. DOI: 10.1097/00005131-200009000-00001.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.