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Acta ortopédica mexicana

versión impresa ISSN 2306-4102


AGUILA-LEDESMA, IR et al. Surgical decision pattern in the prescription of MESS-scale amputations in tibia fractures exposed grade III-B Gustilo-Anderson. Acta ortop. mex [online]. 2019, vol.33, n.1, pp.2-7.  Epub 19-Mayo-2021. ISSN 2306-4102.


The management of severely traumatized extremity continues to be a matter of debate. Gustilo-Anderson tibial fractures III-B have a wide spectrum of variants, there are no guidelines using this classification for management. MESS has demonstrated functional and prognostic association.


To identify the pattern of decision made by surgeons for the prescription of amputations in tibial fractures exposed grade III-B Gustilo-Anderson with MESS scale.

Material and methods:

This is a descriptive, observational, prospective, transversal, analytical study. One hundred thirty-one orthopedists from a traumatic pathology referral center were evaluated, using the MESS scale to evaluate 10 representative clinical cases of Gustilo-Anderson grade III-B tibial fractures presented in an electronic device. The concordance of the decisions between working surgeons and experts was evaluated. Inferential analysis was performed using the χ2 (p < 0.05) of the study variables: surgeon experience, academic postgraduate studies, frequent clinical practice of amputations, concordance of decisions with MESS scale with respect to the prescription pattern obtained by experts.


There was no association between the variables, with the application of MESS. (χ2 = 1.28, p = 0.2575). Surgeons of more than 10 years, increased once the possibility of matching the result of experts (OR = 2.088, 95% CI) (p = 0.0066).


Academic degrees, surgical experience, and frequent clinical practice do not influence the correct application of the MESS scale. Surgeons with more than 10 years of experience have doubled the possibility of a precise decision.

Palabras llave : Mangled lower extremity; open tibial fractures; traumatic limb amputation; amputation prediction scales; management.

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