From the Department of Orthopaedic Surgery (J.C.R.), US Army Institute of Surgical Research and San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas; US Army Institute of Surgical Research (R.M.G.), JBSA Fort Sam Houston, Texas; Joint Trauma System (M.A.S.), JBSA Fort Sam Houston, Texas; and Department of Orthopaedic Surgery (A.E.J.), San Antonio Military Medical Center, JBSA Fort Sam Houston, Texas.
J Trauma Acute Care Surg. 2016 Nov;81(5 Suppl 2 Proceedings of the 2015 Military Health System Research Symposium):S100-S103. doi: 10.1097/TA.0000000000001145.
The Military Orthopaedic Trauma Registry (MOTR) was designed to replicate the Department of Defense Trauma Registry's (DoDTR's) role as pillar for data-driven management of extremity war wounds. The MOTR continuously undergoes quality assurance checks to optimize the registry data for future quality improvement efforts. We conducted a quality assurance survey of MOTR entrants to determine if a simple MOTR data pull could provide robust orthopedic-specific information toward the question of causes for late amputation.
Forty-five entrants into the DoDTR with late transtibial amputation were sequentially abstracted into MOTR by MOTR data abstractors. The MOTR record was then examined by an independent reviewer for three data fields pertaining to the events leading up to the late amputation: injury before limb amputation, complications before and after amputation, and complication or other factor directly contributing to the decision for amputation.
Thirty-nine subjects had at least one fracture of the tibial diaphysis, tibial pilon, calcaneus, or multiple foot fractures. Twenty-nine fractures were described as open injuries for which 27 included a Gustilo and Anderson classification in the available data fields. Complications could be identified along the treatment course for 43 of the 45 entrants specific to the amputated limb. A directly contributing factor to late amputation was identified in 36 (80%) of the subjects. Infection, either alone or associated with fracture nonunion, was a contributing factor in 46% of late amputations. Wound infection was the most common complication both before and after the amputation.
The MOTR, using a simple data extraction from a few registry fields, can provide a robust amount of information that can direct process and care improvement for severely injured limbs by providing the level of detail pertinent to an orthopedic surgeon.
Prognostic/epidemiological study, level IV.
军事骨科创伤登记处（MOTR）旨在复制国防部创伤登记处（DoDTR）的作用，作为管理四肢战伤的数据驱动支柱。MOTR 不断进行质量保证检查，以优化登记处数据，为未来的质量改进工作提供支持。我们对 MOTR 参与者进行了质量保证调查，以确定简单的 MOTR 数据提取是否可以为导致晚期截肢的原因这一问题提供强有力的骨科特定信息。
通过 MOTR 数据提取员，将 DoDTR 中 45 例晚期胫骨截肢患者连续纳入 MOTR。然后，由独立审查员检查 MOTR 记录，以了解导致晚期截肢的三个数据字段：截肢前的损伤、截肢前后的并发症以及直接导致截肢决定的并发症或其他因素。
39 例患者至少有一处胫骨骨干、胫骨 pilon、跟骨或多处足部骨折。29 处骨折被描述为开放性损伤，其中 27 处可在可用数据字段中找到 Gustilo 和 Anderson 分类。45 例患者中有 43 例在截肢肢体的治疗过程中可以识别出并发症。36 例（80%）患者确定了导致晚期截肢的直接因素。感染是导致晚期截肢的一个因素，单独或与骨折不愈合相关，占晚期截肢的 46%。感染是截肢前后最常见的并发症。
MOTR 通过从几个登记字段中简单提取数据，可以提供大量信息，通过提供与骨科医生相关的详细信息，为严重受伤的肢体提供流程和护理改进方向。
预后/流行病学研究，IV 级。
