Journal of clinical orthopaedics and trauma · 2026
Retrospective cohort analysis of influence of mode of injury on reconstructive outcomes following lower extremity trauma.
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Badiee Ryan K, Taslakian Editt N, Vu Stephanie, Friedrich Jeffrey B, Keys Kari, Crowe Christopher S
Аннотация
BACKGROUND: Traumatic lower extremity injuries occur secondary to diverse and modes of injury (MOI), yet the relationship between MOI and reconstructive outcomes remains poorly defined. This study sought to evaluate the independent association between mode of injury (MOI) and post-reconstructive bony and soft tissue outcomes in lower extremity trauma.
METHODS: Patients with lower extremity trauma who underwent orthopedic and soft tissue reconstruction at a Level I trauma center (1994-2024) were retrospectively reviewed in this retrospective cohort study. Those with <30 days of follow-up were excluded. MOI including motor vehicle collision (MVC), motorcycle collision (MCC), blast or ballistic injuries, crush or avulsion injuries, ground level falls (GLFs), and collisions between automobiles and pedestrians or bicyclists were compared. Univariate analyses used t-tests, Chi-square, and Fisher's exact tests; variables with p < 0.10 were included in multivariable logistic and linear regression models.
RESULTS: A total of 251 patients were included. MVCs were associated with significantly longer hospitalizations (β = 16.9 days, p = 0.02), independent of injury severity or flap type. Pedestrian and bicycle injuries were associated with a decreased likelihood of return to the operating room (OR 0.3, p = 0.045). In contrast, MCC, crush, blast or ballistic, and fall-related injuries were not independently associated with prolonged hospitalization, surgical complications, or reoperation. High-energy injury classification, based on the modified Mangled Extremity Severity Score (MESS), was also not predictive of adverse outcomes. The rate of tissue necrosis in crush injuries was not significantly elevated despite higher rates of free tissue transfer.
CONCLUSIONS: High-energy modes do not universally predict worse reconstructive outcomes. When appropriately timed, crush injuries do not increase necrosis risk. However, MVCs are independently associated with significantly longer hospitalizations, underscoring the systemic complexity and resource intensity of these injuries.
METHODS: Patients with lower extremity trauma who underwent orthopedic and soft tissue reconstruction at a Level I trauma center (1994-2024) were retrospectively reviewed in this retrospective cohort study. Those with <30 days of follow-up were excluded. MOI including motor vehicle collision (MVC), motorcycle collision (MCC), blast or ballistic injuries, crush or avulsion injuries, ground level falls (GLFs), and collisions between automobiles and pedestrians or bicyclists were compared. Univariate analyses used t-tests, Chi-square, and Fisher's exact tests; variables with p < 0.10 were included in multivariable logistic and linear regression models.
RESULTS: A total of 251 patients were included. MVCs were associated with significantly longer hospitalizations (β = 16.9 days, p = 0.02), independent of injury severity or flap type. Pedestrian and bicycle injuries were associated with a decreased likelihood of return to the operating room (OR 0.3, p = 0.045). In contrast, MCC, crush, blast or ballistic, and fall-related injuries were not independently associated with prolonged hospitalization, surgical complications, or reoperation. High-energy injury classification, based on the modified Mangled Extremity Severity Score (MESS), was also not predictive of adverse outcomes. The rate of tissue necrosis in crush injuries was not significantly elevated despite higher rates of free tissue transfer.
CONCLUSIONS: High-energy modes do not universally predict worse reconstructive outcomes. When appropriately timed, crush injuries do not increase necrosis risk. However, MVCs are independently associated with significantly longer hospitalizations, underscoring the systemic complexity and resource intensity of these injuries.