A Qualitative Analysis of the Decision-making Process for Patients with Severe Lower Leg Trauma

Overview

Journal Plast Reconstr Surg

Specialty General Surgery

Date 2010 Aug 11

PMID 20697318

Citations 9

Authors

Maya Aravind

Melissa J Shauver

Kevin C Chung

Affiliations

Soon will be listed here.

Abstract

Background: Choosing the appropriate treatment for grade IIIB and IIIC open tibial fractures is a difficult decision for both the patient and the physician. Current research shows that the functional outcomes for reconstruction are similar to those for below-knee amputation, but little investigation of the qualitative outcomes of either treatment option has been performed from the patient perspective. This study was designed to perform a qualitative analysis of patient preferences for amputation or reconstruction.

Methods: Twenty patients with type IIIB or IIIC open tibial fractures participated in the study. These patients had undergone either amputation or reconstruction between 1997 and 2007. Semistructured interviews were conducted and qualitative outcomes were assessed.

Results: Interviews highlighted several issues involved with medical decision-making. Participants described not having a role in deciding which medical treatment to choose. Family and spouses played a greater role, often because of patients being medicated when needing to make a treatment choice. Both amputation and reconstruction patients described being satisfied with the outcomes of their surgical treatments, but also expressed second thoughts about their treatment choices.

Conclusions: The findings of this study emphasize how difficult it is to assign preference to one medical treatment over another. The study reveals how the role of the patient is limited in making a decision about pursuing amputation or reconstruction. Instead, there is a continued need for physicians to discuss treatment options and risks with family members who act on the patient's behalf, and to incorporate the patient's preference in this complex decision.

Citing Articles

Complex Limb Injuries: Limb Salvage Versus Amputation-A Mini Review and Meta-Analysis.

Serlis A, Sgardelis P, Vampertzis T, Rizavas K, Poulios P, Konstantopoulos G Adv Orthop. 2025; 2025:2884802.

PMID: 39950183 PMC: 11824304. DOI: 10.1155/aort/2884802.

Secondary amputation: a qualitative study of quality of life in patients after primary limb salvage surgery and after later ablative sarcoma treatment.

Vetchy V, Trost C, Windhager R, Hobusch G J Rehabil Med. 2025; 57:jrm34888.

PMID: 39873158 PMC: 11795125. DOI: 10.2340/jrm.v57.34888.

Impact of bone quality on surgical decision-making in total hip arthroplasty: a qualitative analysis in the UK.

Karia M, Abouharb A, Sabharwal S, Mavroveli S, Cobb J BMJ Open. 2025; 15(1):e088081.

PMID: 39753255 PMC: 11749845. DOI: 10.1136/bmjopen-2024-088081.

Limb salvage versus primary amputation in Gustilo-Anderson IIIB and IIIC tibial fractures: a systematic review and meta-analysis.

Ng H, Ang E, Premchand A, Rajaratnam V Arch Orthop Trauma Surg. 2023; 143(8):4961-4976.

PMID: 36781435 DOI: 10.1007/s00402-023-04804-2.

Why Rotationplasty? A Qualitative Study of Decision-Making by Families of Patients With Primary Bone Sarcoma.

Chan C, Lindsay A, Spiguel A, Gibbs C, Scarborough M J Patient Exp. 2022; 9:23743735211069818.

PMID: 35005220 PMC: 8733356. DOI: 10.1177/23743735211069818.

References

Hertel R, Strebel N, Ganz R . Amputation versus reconstruction in traumatic defects of the leg: outcome and costs. J Orthop Trauma. 1996; 10(4):223-9. DOI: 10.1097/00005131-199605000-00001. View

MacKenzie E, Bosse M, Pollak A, Webb L, Swiontkowski M, Kellam J . Long-term persistence of disability following severe lower-limb trauma. Results of a seven-year follow-up. J Bone Joint Surg Am. 2005; 87(8):1801-9. DOI: 10.2106/JBJS.E.00032. View

MacKenzie E, Bosse M, Kellam J, Burgess A, Webb L, Swiontkowski M . Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma. 2002; 52(4):641-9. DOI: 10.1097/00005373-200204000-00005. View

Haider A, Edwin D, MacKenzie E, Bosse M, Castillo R, Travison T . The use of the NEO-five factor inventory to assess personality in trauma patients: a two-year prospective study. J Orthop Trauma. 2002; 16(9):660-7. DOI: 10.1097/00005131-200210000-00008. View

Chung K, Saddawi-Konefka D, Haase S, Kaul G . A cost-utility analysis of amputation versus salvage for Gustilo type IIIB and IIIC open tibial fractures. Plast Reconstr Surg. 2009; 124(6):1965-1973. PMC: 2788746. DOI: 10.1097/PRS.0b013e3181bcf156. View

Hollenbeck S, Woo S, Ong S, Fitch R, Erdmann D, Levin L . The combined use of the Ilizarov method and microsurgical techniques for limb salvage. Ann Plast Surg. 2009; 62(5):486-91. DOI: 10.1097/SAP.0b013e318189a9e5. View

Lantz P, Janz N, Fagerlin A, Schwartz K, Liu L, Lakhani I . Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res. 2005; 40(3):745-67. PMC: 1361166. DOI: 10.1111/j.1475-6773.2005.00383.x. View

Ly T, Travison T, Castillo R, Bosse M, MacKenzie E . Ability of lower-extremity injury severity scores to predict functional outcome after limb salvage. J Bone Joint Surg Am. 2008; 90(8):1738-43. PMC: 2657307. DOI: 10.2106/JBJS.G.00136. View

Clark J, Wray N, Ashton C . Living with treatment decisions: regrets and quality of life among men treated for metastatic prostate cancer. J Clin Oncol. 2001; 19(1):72-80. DOI: 10.1200/JCO.2001.19.1.72. View

10.

MacKenzie E, Bosse M . Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP). J Am Acad Orthop Surg. 2006; 14(10 Spec No.):S205-10. DOI: 10.5435/00124635-200600001-00044. View

11.

Parrett B, Matros E, Pribaz J, Orgill D . Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plast Reconstr Surg. 2006; 117(4):1315-22. DOI: 10.1097/01.prs.0000204959.18136.36. View

12.

Olver J, Ponsford J, Curran C . Outcome following traumatic brain injury: a comparison between 2 and 5 years after injury. Brain Inj. 1996; 10(11):841-8. DOI: 10.1080/026990596123945. View

13.

Giacomini M, Cook D . Users' guides to the medical literature: XXIII. Qualitative research in health care B. What are the results and how do they help me care for my patients? Evidence-Based Medicine Working Group. JAMA. 2000; 284(4):478-82. DOI: 10.1001/jama.284.4.478. View

14.

Ducic I, Rao S, Attinger C . Outcomes of microvascular reconstruction of single-vessel lower extremities: limb salvage versus amputation. J Reconstr Microsurg. 2009; 25(8):475-8. DOI: 10.1055/s-0029-1225536. View

15.

Hoogendoorn J, van der Werken C . Grade III open tibial fractures: functional outcome and quality of life in amputees versus patients with successful reconstruction. Injury. 2001; 32(4):329-34. DOI: 10.1016/s0020-1383(00)00250-3. View

16.

Bunch W . Informed consent. Clin Orthop Relat Res. 2000; (378):71-7. DOI: 10.1097/00003086-200009000-00012. View

17.

MacKenzie E, Snow Jones A, Bosse M, Castillo R, Pollak A, Webb L . Health-care costs associated with amputation or reconstruction of a limb-threatening injury. J Bone Joint Surg Am. 2007; 89(8):1685-92. DOI: 10.2106/JBJS.F.01350. View

18.

Giannoudis P, Harwood P, Kontakis G, Allami M, MacDonald D, Kay S . Long-term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture, grade IIIB/IIIC open fracture and amputation). Injury. 2008; 40(2):213-9. DOI: 10.1016/j.injury.2008.05.024. View

19.

Horgan O, Maclachlan M . Psychosocial adjustment to lower-limb amputation: a review. Disabil Rehabil. 2004; 26(14-15):837-50. DOI: 10.1080/09638280410001708869. View

20.

OToole R, Castillo R, Pollak A, MacKenzie E, Bosse M . Determinants of patient satisfaction after severe lower-extremity injuries. J Bone Joint Surg Am. 2008; 90(6):1206-11. PMC: 2657303. DOI: 10.2106/JBJS.G.00492. View