Characterizing The Influence Of Mechanism Of Injury On Post-Reconstructive Outcomes Following Lower Extremity Trauma
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2026
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| author | Ryan Badiee Stephanie Vu Editt Taslakian Mahsa Taskindoust Gillian O'Connell Jeffrey Friedrich Katie Liu Kari Keys Christopher Crowe |
| author_facet | Ryan Badiee Stephanie Vu Editt Taslakian Mahsa Taskindoust Gillian O'Connell Jeffrey Friedrich Katie Liu Kari Keys Christopher Crowe |
| contents | PURPOSE: Patients with lower extremity trauma present with myriad different mechanisms of injury. High-energy trauma, such as crush injuries and gunshot wounds (GSWs), often result in extensive soft tissue and vascular damage, potentially leading to higher rates of necrosis, infection, and delayed healing. Understanding whether specific mechanisms of injury are associated with complications can help guide clinical decision-making, including the timing of and approach to soft tissue coverage. Accordingly, this study aims to characterize the independent influence of mechanism of injury on a variety of bony and soft tissue post-reconstructive outcomes. METHODS: Patients with lower extremity trauma who underwent orthopedic and soft tissue reconstruction at a single, level I trauma center from 1994 to 2024 were identified from the medical record. Those with less than 30 days of post-reconstructive follow up were excluded. Univariate analyses were made using Student's T test, Chi square tests, and Fisher's exact tests. Variables significant at p0.2 were incorporated into logistic and linear multiple regression models to evaluate the independent association of each predictor. RESULTS: Of the 251 patients who met inclusion criteria, MOIs included motor vehicle collisions (MVCs, n=52 [20.7%]), motorcycle collisions (MCCs, n=86 [n=86, 34.3%]), crush or mangling injuries (n=24, 9.6%), ballistic injuries (n=19, 7.6%), car vs pedestrian or cyclist (n=27, 10.8%), falls (n=21, 8.4%), or other (n=22, 8.8%). Overall, 140 patients (55.8%) experienced one or more complications, with 57 (22.7%) developing a surgical site infection and 18 (7.2%) developing tissue necrosis surrounding their soft tissue reconstruction. Of note, the rate of surrounding tissue necrosis was not higher in crush or mangling injuries (n=1 [4.2%] vs n=17 [7.5%], p 0.99) despite similar times from injury, debridement, and bony fixation to reconstruction compared to other mechanisms ( p 0.05, all comparisons). Patients who collided with a vehicle while on a bike or on foot were significantly less likely to experience a bony complication including hardware infection, nonunion, or osteomyelitis (OR 0.18 [0.03-0.69], p =0.03) or require postoperative return to the operating room within 30 days (OR 0.30 [0.08-0.92], p =0.04). By contrast, a higher proportion of patients with MCC developed bony complication including nonunion, hardware infection, and osteomyelitis (n=37 [43.0%] vs n=49 [29.7%] p =0.04) though this did not represent an independent predictor on multivariable analysis (OR 1.8 [0.8-4.2], p =0.16). MVC-related injuries were independently associated with prolonged hospital stays (19.5 [3.8-35.3]) days longer, p =0.02, Table 1). Likewise, falls were associated with decreased length of stay on univariate analysis (24.0±13.0 vs 34.1±36.7 days, p =0.01), but this effect was attenuated on multivariable regression ( p 0.05). CONCLUSION: High energy mechanisms of injury, including automobile versus pedestrian collisions, do not necessarily predispose patients to higher rates of post-reconstructive complication. Likewise, an appropriate interval from time of injury to reconstruction following crush injuries obviates the potential for delayed tissue necrosis. Further investigation should be pursued to determine whether specific subgroups may benefit from earlier intervention. Table 1. MVC is associated with prolonged hospital stay on multiple logistic regression Variable Coefficient [95% CI], days P-value MVC 14.9 [0.9, 29.0] 0.04* Age 0.2 [-0.2, 0.5] 0.34 BMI 0.1 [-0.9, 1.0] 0.90 Diabetes -1.0 [-24.3, 22.4] 0.94 Other Orthopedic Injuries -12.9 [-27.9, 2.1] 0.09 ICU Admission 6.6 [-6.0, 19.3] 0.30 Left Lower Extremity Injury -4.4 [-14.8, 5.9] 0.40 Free Flap Reconstruction 6.2 [-4.9, 9.4] 0.27 Additional Organ Systems Injured 4.5 [-0.4, 9.4] 0.07 |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_20088429 |
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| publishDate | 2026 |
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| spellingShingle | Characterizing The Influence Of Mechanism Of Injury On Post-Reconstructive Outcomes Following Lower Extremity Trauma Ryan Badiee Stephanie Vu Editt Taslakian Mahsa Taskindoust Gillian O'Connell Jeffrey Friedrich Katie Liu Kari Keys Christopher Crowe plastic surgery reconstructive surgery conference abstract PSRC 2026 PURPOSE: Patients with lower extremity trauma present with myriad different mechanisms of injury. High-energy trauma, such as crush injuries and gunshot wounds (GSWs), often result in extensive soft tissue and vascular damage, potentially leading to higher rates of necrosis, infection, and delayed healing. Understanding whether specific mechanisms of injury are associated with complications can help guide clinical decision-making, including the timing of and approach to soft tissue coverage. Accordingly, this study aims to characterize the independent influence of mechanism of injury on a variety of bony and soft tissue post-reconstructive outcomes. METHODS: Patients with lower extremity trauma who underwent orthopedic and soft tissue reconstruction at a single, level I trauma center from 1994 to 2024 were identified from the medical record. Those with less than 30 days of post-reconstructive follow up were excluded. Univariate analyses were made using Student's T test, Chi square tests, and Fisher's exact tests. Variables significant at p0.2 were incorporated into logistic and linear multiple regression models to evaluate the independent association of each predictor. RESULTS: Of the 251 patients who met inclusion criteria, MOIs included motor vehicle collisions (MVCs, n=52 [20.7%]), motorcycle collisions (MCCs, n=86 [n=86, 34.3%]), crush or mangling injuries (n=24, 9.6%), ballistic injuries (n=19, 7.6%), car vs pedestrian or cyclist (n=27, 10.8%), falls (n=21, 8.4%), or other (n=22, 8.8%). Overall, 140 patients (55.8%) experienced one or more complications, with 57 (22.7%) developing a surgical site infection and 18 (7.2%) developing tissue necrosis surrounding their soft tissue reconstruction. Of note, the rate of surrounding tissue necrosis was not higher in crush or mangling injuries (n=1 [4.2%] vs n=17 [7.5%], p 0.99) despite similar times from injury, debridement, and bony fixation to reconstruction compared to other mechanisms ( p 0.05, all comparisons). Patients who collided with a vehicle while on a bike or on foot were significantly less likely to experience a bony complication including hardware infection, nonunion, or osteomyelitis (OR 0.18 [0.03-0.69], p =0.03) or require postoperative return to the operating room within 30 days (OR 0.30 [0.08-0.92], p =0.04). By contrast, a higher proportion of patients with MCC developed bony complication including nonunion, hardware infection, and osteomyelitis (n=37 [43.0%] vs n=49 [29.7%] p =0.04) though this did not represent an independent predictor on multivariable analysis (OR 1.8 [0.8-4.2], p =0.16). MVC-related injuries were independently associated with prolonged hospital stays (19.5 [3.8-35.3]) days longer, p =0.02, Table 1). Likewise, falls were associated with decreased length of stay on univariate analysis (24.0±13.0 vs 34.1±36.7 days, p =0.01), but this effect was attenuated on multivariable regression ( p 0.05). CONCLUSION: High energy mechanisms of injury, including automobile versus pedestrian collisions, do not necessarily predispose patients to higher rates of post-reconstructive complication. Likewise, an appropriate interval from time of injury to reconstruction following crush injuries obviates the potential for delayed tissue necrosis. Further investigation should be pursued to determine whether specific subgroups may benefit from earlier intervention. Table 1. MVC is associated with prolonged hospital stay on multiple logistic regression Variable Coefficient [95% CI], days P-value MVC 14.9 [0.9, 29.0] 0.04* Age 0.2 [-0.2, 0.5] 0.34 BMI 0.1 [-0.9, 1.0] 0.90 Diabetes -1.0 [-24.3, 22.4] 0.94 Other Orthopedic Injuries -12.9 [-27.9, 2.1] 0.09 ICU Admission 6.6 [-6.0, 19.3] 0.30 Left Lower Extremity Injury -4.4 [-14.8, 5.9] 0.40 Free Flap Reconstruction 6.2 [-4.9, 9.4] 0.27 Additional Organ Systems Injured 4.5 [-0.4, 9.4] 0.07 |
| title | Characterizing The Influence Of Mechanism Of Injury On Post-Reconstructive Outcomes Following Lower Extremity Trauma |
| topic | plastic surgery reconstructive surgery conference abstract PSRC 2026 |
| url | https://doi.org/10.5281/zenodo.20088429 |