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Factors Influencing Outcome Following Limb-Threatening Lower Limb Trauma: Lessons Learned From the Lower Extremity Assessment Project (LEAP)

Dr. MacKenzie is Professor and Chair, Health Policy and Management, The Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD. Dr. Bosse is Director, Clinical Research, and Orthopaedic Traumatologist, Carolinas Medical Center, Charlotte, NC.

Dr. MacKenzie or the department with which she is affiliated has received research or institutional support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Neither Dr. Bosse nor the department with which he is affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

The Lower Extremity Assessment Project (LEAP) is a multicenter study of severe lower extremity trauma in the US civilian population. At 2- and 7-year follow-ups, the LEAP study found no difference in functional outcome between patients who underwent either limb salvage surgery or amputation. However, outcomes on average were poor for both groups. This study and others provide evidence of wide-ranging variations in outcome following major limb trauma, with a substantial proportion of patients experiencing long-term disability. In addition, outcomes often are more affected by the patient's economic, social, and personal resources than by the initial treatment of the injury—specifically, amputation or reconstruction and level of amputation. A conceptual framework for examining outcomes after injury may be used to identify opportunities for interventions that would improve outcomes. Because of essential differences between the civilian and military populations, the findings of the LEAP study may correlate only roughly with combat casualty outcomes.

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