Outcomes Following Severe Distal Tibia, Ankle and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation Protocol

NCT ID: NCT01606501

Last Updated: 2021-03-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

664 participants

Study Classification

OBSERVATIONAL

Study Start Date

2012-05-31

Study Completion Date

2019-09-20

Brief Summary

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The primary aim this prospective longitudinal observational outcomes study is to compare 18 month functional outcomes and health related quality of life (HRQoL) of patients undergoing salvage versus amputation following severe distal tibia, ankle and/or foot fractures with major soft tissue, bone and/or ankle articular surface loss. Functional outcomes and HRQoL will be measured using well established self reported measures, including the Veterans Rand Health Survey (VR-12) and the Short Musculoskeletal Functional Assessment (SMFA).

Hypothesis 1: As a group, salvage patients with severe distal tibia, ankle and/or foot injuries with major soft tissue, bone and/or ankle articular surface loss will have similar functional outcomes and HRQoL had they undergone a transtibial amputation (within 6 weeks of injury).

Hypothesis 2: The subgroup of salvage patients who have either (1) a soft tissue injury that requires tissue transfer; (2) articular damage requiring arthrodesis of the ankle joint; or (3) bone loss at the distal tibia or ankle will have better functional outcomes and HRQoL had they undergone a transtibial amputation (within 6 weeks of injury).

Detailed Description

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Conditions

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Severe Distal Tibia Injury Severe Ankle Injury Severe Foot Injury Major Soft Tissue Loss Major Bone Articular Surface Loss Major Ankle Articular Surface Loss

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Limb Salvage patients

Patients undergoing limb salvage following severe distal tibia, ankle and/or foot injuries with major soft tissue, bone and/or ankle articular surface loss.

No interventions assigned to this group

Transtibial Amputation patients

Patients undergoing transtibial amputation following severe distal tibia, ankle and/or foot injuries with major soft tissue, bone and/or ankle articular surface loss.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

1. Patients with an injury that meets at least one of the following:

1. Gustilo type III pilon fractures consistent with one of the following OTA codes: 43B1.3, 43B2-B3, 43C, 44B, 44C
2. Gustilo type III B or C ankle fractures
3. Gustilo type III mid and/or hind foot fractures consistent with one of the following OTA codes: 81B2-B3, 82B and 82C
4. Open foot crush or blast injuries from high energy mechanism involving the mid and /or hind foot with significant soft tissues damage
5. Other severe foot injury (including closed foot crush or blast injuries)
2. Ages 18-60 inclusive.
3. Admitted to the hospital prior to definitive wound closure.

Inclusion notes:

Exclusion Criteria

2. Foot crush and blast injuries are eligible if they are considered to be at significant risk for impaired outcome with moderate to severe disability and typically include one of the following associated injuries:

1. ankle dislocation (80A)
2. subtalar dislocation (80B)
3. extruded talus
4. chopart dislocation (80C)
5. multiple midfoot dislocations (80C)
6. three or greater proximal metatarsal fractures
7. heel pad/plantar degloving
8. extensive muscle necrosis in an open injury from crush, ischemia and/or foot compartment syndrome
3. These injuries may include "toe-pan" injuries from motor vehicle accidents and crush-like injuries from motorcycle accidents, and traumatic amputations.


1. Patient has a Glasgow Coma Scale motor score of 0-4 or a Glasgow Coma Scale motor score of 5 with a significant traumatic brain injury (defined as an AIS code of 5 or 6) at time of consent
2. Patient has third degree burns on \>10% total surface area affecting the study limb
3. Patient has a previous leg or foot amputation of either limb
4. Patient is non-ambulatory due to an associated complete spinal cord injury
5. Patient non-ambulatory pre-injury
6. Patient speaks neither English nor Spanish
7. Patient likely to have severe problems with maintaining follow- up due to at least one of the following:

1. Patient has been diagnosed with a severe psychiatric condition
2. Patient is intellectually challenged without adequate family support
3. Patient lives outside the hospital's catchment area
4. Follow-up is planned at another medical center
5. Patients who are prisoners or homeless
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Major Extremity Trauma Research Consortium

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Michael J Bosse, MD

Role: PRINCIPAL_INVESTIGATOR

Carolinas Medical Center

Lisa Reider, MHS, PhD

Role: STUDY_DIRECTOR

Johns Hopkins Bloomberg School of Public Health

Locations

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University of Alabama at Birmingham

Birmingham, Alabama, United States

Site Status

Navy Medical Center San Diego

San Diego, California, United States

Site Status

University of California San Francisco Medical Center

San Francisco, California, United States

Site Status

Denver Health and Hospital Authority

Denver, Colorado, United States

Site Status

Walter Reed National Military Medical Center

Washington D.C., District of Columbia, United States

Site Status

University of Miami Ryder Trauma Center

Miami, Florida, United States

Site Status

Orlando Regional Medical Center

Orlando, Florida, United States

Site Status

Florida Orthopaedic Institute, St. Joseph's Hospital

Tampa, Florida, United States

Site Status

Florida Orthopaedic Institute, Tampa General Hospital

Tampa, Florida, United States

Site Status

Eskenazi Health

Indianapolis, Indiana, United States

Site Status

OrthoIndy Methodist Hospital

Indianapolis, Indiana, United States

Site Status

St. Vincent Indianapolis Hospital

Indianapolis, Indiana, United States

Site Status

University of Iowa Medical Center

Iowa City, Iowa, United States

Site Status

University of Maryland Medical Center

Baltimore, Maryland, United States

Site Status

Orthopaedic Associates of Michigan

Grand Rapids, Michigan, United States

Site Status

Hennepin County Medical Center

Minneapolis, Minnesota, United States

Site Status

University of Mississippi Medical Center

Jackson, Mississippi, United States

Site Status

Barnes Jewish Hospital

St Louis, Missouri, United States

Site Status

St. Louis University Medical Center

St Louis, Missouri, United States

Site Status

Jamaica Hospital Medical Center

Jamaica, New York, United States

Site Status

Carolinas Medical Center

Charlotte, North Carolina, United States

Site Status

Duke University Medical Center

Durham, North Carolina, United States

Site Status

Wake Forest Baptist Medical Center

Winston-Salem, North Carolina, United States

Site Status

MetroHealth

Cleveland, Ohio, United States

Site Status

Oklahoma University Medical Center

Oklahoma City, Oklahoma, United States

Site Status

Penn State Hershey Medical Center

Hershey, Pennsylvania, United States

Site Status

University of Pittsburgh Medical Center

Pittsburgh, Pennsylvania, United States

Site Status

Rhode Island/ Brown University

Providence, Rhode Island, United States

Site Status

Vanderbilt Medical Center

Nashville, Tennessee, United States

Site Status

University of Texas Health Science Center at Houston

Houston, Texas, United States

Site Status

San Antonio Military Medical Center

San Antonio, Texas, United States

Site Status

University of Virginia

Charlottesville, Virginia, United States

Site Status

University of Washington/Harborview Medical Center

Seattle, Washington, United States

Site Status

Countries

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United States

References

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McLaughlin KH, Mitchell SL, Archer KR, Master H, Morshed S, Gary JL, Jones CB, MacKenzie EJ, Reider L; METRC. Effect of Severe Distal Tibia, Ankle, and Mid- to Hindfoot Trauma on Meeting Physical Activity Guidelines 18 Months After Injury. Arch Phys Med Rehabil. 2022 Mar;103(3):409-417.e2. doi: 10.1016/j.apmr.2021.07.805. Epub 2021 Aug 21.

Reference Type DERIVED
PMID: 34425087 (View on PubMed)

Other Identifiers

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W81XWH-09-2-0108-OUT

Identifier Type: -

Identifier Source: org_study_id

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