The short musculoskeletal functional assessment (SMFA) score amongst surgical patients with reconstructive lower limb injuries in war wounded civilians.

BACKGROUND/OBJECTIVES: The MSF programme in Jordan provides specialized reconstructive surgical care to war-wounded civilians in the region. The short musculoskeletal functional assessment score (SMFA) provides a method for quantitatively assessing functional status following orthopaedic trauma. In June 2010 the Amman team established SMFA as the standard for measuring patients' functional status. The objective of this retrospective study is to evaluate whether the SMFA scores can be useful for patients with chronic war injuries. METHODS: All patients with lower limb injuries requiring reconstruction were enrolled in the study. Each patient's SMFA was assessed at admission, at discharge from Amman and during follow-up in home country. In the analysis we compared patients with infected versus non-infected injuries as well as with both high and low admissions dysfunctional index (ADI). RESULTS: Among infected patients, higher ADI correlated with more surgeries and longer hospital stay. Infected patients with ADI >50 required an average of 2.7 surgeries while those with ADI <50, averaged 1.7 operations (p = 0.0809). Non-infected patients with ADI >50 required an average of 1.6 operations compared to 1.5 for those with ADI <50 (p = 0.4168). CONCLUSIONS: The ADI score in our sample appeared to be useful in two areas: (1) hospital course in patients with infection, where a high ADI score correlated with longer hospital stays and more surgeries, and (2) prognosis, which was better for non-infected patients who had high ADI scores. A scoring system that predicts functional outcome following surgical reconstruction of lower limb injuries would be enormously useful.

Reconstruction of nonunion tibial fractures in war-wounded Iraqi civilians, 2006-2008: better late than never.

OBJECTIVE: To describe medical care and surgical outcome after functional reconstructive surgery in late-presenting patients who already had at least one prior operation. DESIGN: Retrospective review of medical care and surgical outcome from August 2006 to December 2008 using patient records for initial data with active follow-up for the latest outcome information. SETTING: Médecins sans Frontières surgical programme in Jordan Red Crescent Hospital, Amman, Jordan. PATIENTS: Sixty-two civilians with nonunion tibial fractures caused by war-related trauma in Iraq; 53 completed follow-up. INTERVENTION: Amputation and/or reconstruction. MAIN OUTCOME MEASUREMENTS: Late surgical complications (after the patient's return to Iraq) were analyzed for infection recurrence, bone union, and functional condition (defined using the Short Musculoskeletal Functional Assessment score). RESULTS: Almost three fourths of patients arrived with infected injuries, 9 of whom had amputation as the initial surgery; the rest, and all uninfected patients, had reconstruction. Excluding loss to follow-up, only 4 of 53 (8%) patients who arrived with an infected injury had infection recurrence. Excluding loss to follow-up and amputation, 2 of 14 (14%) patients in the uninfected and 5 of 30 (17%) in the infected injury group did not achieve successful tibial union. Mean Dysfunctional and Bothersome Indices overall were 27.1 and 29.8, respectively, with similar results for all 3 groups (amputations, uninfected, and infected injuries). CONCLUSIONS: Our study shows that patients with infected and uninfected injuries surgically treated in Amman achieved similar outcomes. Despite late presentation, our patients had a comparable outcome to other studies dealing with early reconstruction. Reconstruction for the infected group required longer treatment time. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.