Complications Following Limb-Threatening Lower Extremity Trauma

OBJECTIVE: Our objective is to report the nature and incidence of major complications after severe lower extremity trauma. DESIGN: Multicenter, prospective, observational study. SETTING: Eight level-1 trauma centers. PATIENTS/PARTICIPANTS: Five hundred forty-five patients were followed for 2 years. INTERVENTION: Amputation or reconstruction. MAIN OUTCOME MEASUREMENTS: The type and number of complications associated with these injuries were recorded at baseline, 3-, 6-, 12-, and 24-month intervals. RESULTS: One hundred forty-nine underwent amputation during the initial hospitalization. The revision amputation rate was 5.4%. Among the amputation group, a complication was noted most frequently at 3 months (24.8%), and the most commonly seen complication was wound infection (34.2%). Wound complications including dehiscence (13.4%) were seen more commonly in the amputation group. Three hundred seventy-one limb reconstructions were performed with 25 patients (3.9%) requiring late amputation. The most frequently reported complication was at 6 months for the salvage group (37.7%), and the most commonly seen complication was wound infection (23.2%). Not surprisingly, osteomyelitis (8.6%) and nonunions (31%) were seen more commonly in the salvage group. Complications of wound infection, osteomyelitis, nonunion, malunion, and prominent hardware resulted in rehospitalization in at least one-third of patients. However, patients who underwent reconstruction were more likely to be hospitalized for these complications. CONCLUSIONS: Patients with severe lower extremity injuries can expect a significant number of complications, most notably wound infection, nonunion, wound necrosis, and osteomyelitis. A large portion of these will require additional inpatient or operative treatment. Patients electing for reconstruction can expect a higher risk of complications.