• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Home
  • TeleConsult
  • About
  • Newsletter/Updates
  • Contact Us
  • Policies

Bone and Spine

Orthopedic health, conditions and treatment

  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors

Mangled Extremity Severity Score

By Dr Arun Pal Singh

In this article
    • Calculation of Mangled Extremity Severity Score
      • Limb ischemia  [If Limb Ischemia present > 6 hours, Limb Ischemia Points are multiplied by 2]
      • Patient age
      • Shock
      • Injury mechanism
    • Inference
      • Related

The Mangled extremity severity score is used in patients with trauma to a limb, particularly lower extremity trauma. As the name suggests, it determines how badly the injured limb is. The score applied to mangled extremities such as limbs overrun by vehicles.

It was developed to discriminate between salvageable and the limbs which would require amputation in course of the treatment.

Mangled extremity score, therefore, can provide an early prognosis on the injured limb at the initial assessment.

mangled extremity severity score
Mangled extremity severity score

Calculation of Mangled Extremity Severity Score

Following Parameters are recorded

Limb ischemia  [If Limb Ischemia present > 6 hours, Limb Ischemia Points are multiplied by 2]

  •  Reduced pulse but normal perfusion
    • +1
  • Pulseless, paresthesiae, slow capillary refill
    • +2
  • Cool, paralysis, numb/insensate
    • +3

Patient age

  • < 30
    • 0
  • 30-50
    • +1
  • ? 50
    • +2

Shock

  • SBP > 90 mmHg consistently
    • 0
  • Transient hypotension
    • +1
  • Persistent hypotension
    • +2

Injury mechanism

  • Low energy (stab, gunshot, simple fracture)
    • +1
  • Medium energy (dislocation, open/multiple fractures)
    • +2
  • High energy (high-speed motor vehicle accident or rifle shot)
    • +3
  • Very high energy (high-speed trauma with gross contamination)
    • +4

Inference

Patients with a MESS > 7 are likely to require amputation secondary to their limb trauma. With modern surgical skills, the limbs are known to perform better even with  7 scores and some authors advocate revising the cutoff.

The original study for mangled extremity severity was published in 1990 by Dr Johansen and colleagues. The score has been subsequently validated in a retrospective study.

It is worthwhile to mention the observation of original creator that no score is an absolute predictor of need for amputation

Mangled extremity severity score can act only as a guide. It is better to use in conjunction with vascular/soft tissue/ bony reconstruction required.

Amputation is a drastic measure which results in loss of limb. The step cannot be modified at any cost. Therefore, all the changes must be given for a limb to survive and clinical observations must be considered instead of absolute reliance on the scoring system.

Related

Spread the Knowledge
 
     

Filed Under: Trauma

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Primary Sidebar

Browse Articles

Open Fracture Femur With Bone Jutting Out

Open Fractures- Features, Classification and Management

Open fractures are fractures where hematoma is in communication with the external environment. An open fracture may have a wound size ranging from a pinprick to complete baring of the bone. Open fractures have been further classified according to their severity and help the treating doctor to plan the treatment and measure the prognosis. Open […]

Faces Pain Scale Revised

Faces Pain Scale – Revised and Wong Baker Pain Rating Scale

The Faces Pain Scale-Revised (FPS-R) is a scale used for a self-report measure of pain intensity. This scale was developed for children and has been adapted from the Faces Pain Scale. It can also be used in adult people who are unable to use a numerical rating scale like visual analog scale. It is particularly recommended […]

Erb's Palsy

Erb’s Palsy Causes, Presentation and Treatment

Erb’s Palsy is also called brachial palsy or Erb Duchenne palsy and it occurs due to injury to the upper group of the arm’s main nerves, specifically of the upper trunk [C5–C6 nerves] Depending on the severity of the injury can either resolve on its own over a period or leave residual weakness. Relevant Anatomy […]

facet joint injection

Facet Joint Injection- Indications and Complications

Facet joint injection is given to diagnose and treat pain originating from facet joint of spine. Facet joint are small but important joints between superior and inferior articular processes. These joints provide  stability and help guide motion. These joints can become painful and cause pain in the back following  arthritis of the spine, a back […]

crawford classification of pseudarthrosis of tibia

Congenital Pseudarthrosis of Tibia

Congenital pseudarthrosis of tibia is an uncommon disease with clinical presentations ranging from simple anterolateral tibial angulation to complete non-union with extensive bone defects. It is a rare disease, with an estimated frequency of 1/150,000 births. Pseudarthrosis means false joint.  A relationship with type 1 neurofibromatosis or von Recklinghausen’s disease is known but exact pathophysiology […]

drug resistant tuberculosis

Drug Resistant Tuberculosis – Types and Treatment

A person is said to have drug-resistant tuberculosis if the tuberculous bacteria that the person is infected with, will not respond to, and are resistant to, at least one of the main antitubercular drugs. Drug-resistant tuberculosis occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no […]

Location of musculoskeletal tumors

Musculoskeletal Tumors – Classification, Diagnosis and Treatment

Musculoskeletal tumors are a rare and diverse group of tumors. Benign bone and soft tissue tumors are 100 times more common than malignant tumors. The musculoskeletal system is made of skin and subcutaneous tissue, lymphatic tissue, vascular structures, musculoaponeurotic tissue, neurological structures, bone, and joints. Musculoskeletal tumors of different histological types can present with similar […]

© Copyright: BoneAndSpine.com
Manage Cookie Consent
The site uses cookies. Please accept cookies for a better visiting experience.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage vendors Read more about these purposes
View preferences
{title} {title} {title}
 

Loading Comments...