Predictive factors for primary amputation in trauma patients in a Nigerian university teaching hospital.

BACKGROUND The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face. OBJECTIVE To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients. DESIGN A prospective study of post-traumatic primary limb amputations. SETTING The Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria from January, 2000 to December, 2004. SUBJECTS Sixty six trauma patients admitted through the Accident and Emergency Unit from January 2000 to December 2004. RESULTS Sixty six traumatised patient limbs were primarily amputated during the study period. The male: female ratio was 3.7:1 and means age was 28.6 years +/- 16.6(range: 4-71 years). 80.3% of the patients were below forty years. All the patients had a single limb amputation. The mean MESS score was 9.4 +/- 1.3 (range: 7.0-12.0). The main predictive factors in trauma at the emergency unit for primary amputation include age, sex, occupation, limb ischaemia, gangrene, severe open fracture, source or nature of injury, presence of shock, delay in hospital presentation, and MESS. CONCLUSION Immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. Identified predictive factors for primary amputation will reduce trauma associated morbidity and mortality.