ortho-trauma emergency

Mangled Extremity Severity Score (MESS)

Predicts the need for amputation in patients with traumatic lower limb injury. Score ≥7 = amputation predictive (97% sensitivity for amputation indication). Assesses skeletal/soft tissue injury, limb ischaemia, shock, and age.

Skeletal/soft tissue injury*

Limb ischaemia*

Score doubled if ischaemia >6 hours duration

Duration of ischaemia >6 hours?*

Shock*

Age (years)*

Score interpretation

Salvageable — Score <7 0–6

MESS <7 — limb salvage likely feasible

→ Attempt limb salvage; orthopaedic/vascular surgery involvement; revascularisation if ischaemic; wound debridement and fixation; antibiotics for open fracture; ATLS protocol; reassess at 24–48h

Amputation Predicted — Score ≥7 7–20

MESS ≥7 — high predictive value for amputation requirement

→ Senior orthopaedic/vascular surgeon discussion; primary amputation may be appropriate; do NOT use MESS alone for amputation decision — clinical context, patient factors, and functional goals must be considered; document discussion with patient and family; trauma MDT; psychological support; prosthetics team early involvement

Interpretation bands for the MESS Score. Apply clinical judgement and local guidance.

References

Johansen K et al. Objective criteria accurately predict amputation following lower extremity trauma. J Trauma. 1990;30(5):568–572.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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