Management of Major Limb Injuries

Table 1

Mangled extremity severity score.

Skeletal/Soft tissue group
Low energy	Stab wounds, simple closed fractures, small caliber gunshot wounds	1
Medium energy	Open or multiple level fracture, dislocations, moderate crush injuries	2
High energy	Shotgun blast (close range), high velocity gunshot wounds	3
Massive crush	Logging, rail road, oil rig accidents	4
Shock group
Normotensive hemodynamics	Blood pressure stable in field and operating room	0
Transiently hypotensive	Blood pressure unstable in field but responsive to intravenous fluids	1
Prolonged hypotensive	Systolic blood pressure <90 mm Hg in field and responsive to intravenous fluids only in operating room	2
Ischemia group
None	Pulsatile limb without signs of ischemia	0
Mild	Diminished pulses without signs of ischemia	1
Moderate	No pulse by doppler, sluggish capillary refill, paresthesia, diminished motor activity	2
Advanced	Pulseless, cool, paralysed and numb without capillary refill	3
Age group
<30 years		0
30–50 years		1
>50 years		2

If ischemia time more than six hours, add 2 points.