@article{cd41e111b4224308a16f702ff9872aff,
title = "Outcomes Following Severe Distal Tibial, Ankle, and/or Mid/Hindfoot Trauma: Comparison of Limb Salvage and Transtibial Amputation (OUTLET)",
abstract = "Background: Selecting the best treatment for patients with severe terminal lower-limb injury remains a challenge. For some injuries, amputation may result in better outcomes than limb salvage. This study compared the outcomes of patients who underwent limb salvage with those that would have been achieved had they undergone amputation. Methods: This multicenter prospective observational study included patients 18 to 60 years of age in whom a Type-III pilon or IIIB or C ankle fracture, a Type-III talar or calcaneal fracture, or an open or closed blast/crush foot injury had been treated with limb salvage (n = 488) or amputation (n = 151) and followed for 18 months. The primary outcome was the Short Musculoskeletal Function Assessment (SMFA). Causal effect estimates of the improvement that amputation would have provided if it had been performed instead of limb salvage were calculated for the SMFA score, physical performance, pain, participation in vigorous activities, and return to work. Results: The patients who underwent limb salvage would have had small differences in most outcomes had they undergone amputation. The most notable difference was an improvement in the SMFA mobility score of 7 points (95% confidence interval [CI] = 2.0 to 10.7). Improvements were largest for pilon/ankle fractures and complex injury patterns. Conclusions: Amputation should be considered a treatment option rather than a last resort for the most complex terminal lower-limb injuries.",
author = "{Major Extremity Trauma Research Consortium (METRC)} and Bosse, {Michael J.} and Carroll, {Eben A.} and Reza Firoozabadi and Gary, {Joshua L.} and Gordon, {Wade T.} and Jones, {Clifford B.} and Saam Morshed and David Teague and Scharfstein, {Daniel O.} and Jason Luly and Mackenzie, {Ellen J.} and Lisa Reider and {Andrews Mcarthur}, Erica and Hsu, {Joseph R.} and Karunakar, {Madhav A.} and {Sample Robinson}, Katherine and Seymour, {Rachel B.} and Sims, {Stephen H.} and Christine Churchill and Fox, {Wade E.} and Mayfield, {Ada P.} and Roman Hayda and Born, {Christopher T.} and Crisco, {Mary Jean} and Cyril Mauffrey and Hak, {David J.} and {Henderson Trujillo}, Corey and Nadeau, {Jason T.} and Reilly, {Rachel M.} and Howes, {Cameron R.} and Thomas Moore and Schenker, {Mara L.} and Taylor, {Benjamin C.} and Schmidt, {Andrew H.} and Jerald Westberg and Mullis, {Brian H.} and Ertl, {Janos P.} and Shively, {Karl D.} and Moore, {Molly M.} and Mckinley, {Todd O.} and Sorkin, {Anthony T.} and Virkus, {Walter W.} and Vallier, {Heather A.} and Breslin, {Mary A.} and Kuhn, {Kevin M.} and Sheu, {Robert G.} and Toledano, {James E.} and Zalewski, {Brian A.} and Konda, {Sanjit R.} and Langford, {Joshua R.} and Harriott, {Paula J.} and Sietsema, {Debra L.} and Reid, {J. Spence} and Andrea Horne and Osborn, {Patrick M.} and Rivera, {Jessica C.} and Stinner, {Daniel J.} and Wilken, {Jason M.} and Cannada, {Lisa K.} and Dawson, {Sarah A.} and Shah, {Anjan R.} and Infante, {Anthony F.} and Benjamin Maxson and Hassan Mir and Sagi, {H. Claude} and David Watson and Barbara Steverson and Theodore Miclau and O'toole, {Robert V.} and Boulton, {Christina L.} and Lebrun, {Christopher T.} and Theodore Manson and Nascone, {Jason W.} and Pollak, {Andrew N.} and Sciadini, {Marcus F.} and Slobogean, {Gerard P.} and Yasmin Degani and Howe, {Andrea L.} and Joshua Rudnicki and Zych, {Gregory A.} and Quinnan, {Stephen M.} and Zych, {Gabriela M.} and Schroder, {Lisa K.} and Vang, {Sandy X.} and Bergin, {Patrick F.} and Graves, {Matt L.} and Russell, {George V.} and Spitler, {Clay A.} and Hydrick, {Josie M.} and William Ertl and Moloney, {Gele B.} and Evans, {Andrew R.} and Tarkin, {Ivan S.} and Achor, {Timothy S.} and Choo, {Andrew M.} and Mcgarvey, {William C.} and Melton, {Danielle H.} and Munz, {John W.} and Mayank Rao and {Lee Routt}, Milton and Boutte, {Sterling J.} and Weiss, {David B.} and Yarboro, {Seth R.} and Veronica Lester-Ballard and Mcvey, {Eric D.} and Bruce Sangeorzan and Julie Agel and Obremskey, {William T.} and Archer, {Kristin R.} and Boyce, {Robert H.} and Burgos, {Eduardo J.} and Vamshi Gajari and Jahangir, {A. Alex} and Molina, {Cesar S.} and Andres Rodriguez-Buitrago and Tummuru, {Rajesh R.} and Trochez, {Karen M.} and Halvorson, {Jason J.} and Miller, {Anna N.} and Holly Pilson and Goodman, {James Brett} and Holden, {Martha B.} and Potter, {Benjamin K.} and D'alleyrand, {Jean Claude G.} and Lucio, {Whitley B.} and Mcandrew, {Christopher M.} and Gardner, {Michael J.} and Ricci, {William M.} and Amanda Spraggs-Hughes and Castillo, {Renan C.} and Allen, {Lauren E.} and Carlini, {Anthony R.} and Dana Alkhoury",
note = "Publisher Copyright: {\textcopyright} 2021 Lippincott Williams and Wilkins. All rights reserved.",
year = "2021",
month = sep,
day = "1",
doi = "10.2106/JBJS.20.01320",
language = "English",
volume = "103",
pages = "1588--1597",
journal = "Journal of Bone and Joint Surgery - Series A",
issn = "0021-9355",
number = "17",
}