Comparative analysis of the results of the Syme’s operation and transtibial amputation in patients with gunshot injuries of the lower limb

Background. Syme’s operation in patients with gunshot injuries of the foot has a number of advantages, but it is performed very rarely. The aim was to conduct a comparative analysis of functional capacity and quality of life in patients with gunshot injuries of the lower limb after Syme’s operation and transtibial amputation (TTA). Materials and methods. Forty-six patients aged 20–63 years with gunshot injuries of the lower limb and their consequences who underwent Syme’s operation (group I, 10 patients) and TTA (group II, 36 patients). The severity of limb injury was determined by the Hannover Fracture Scale-98, functional outcome was assessed by the Short Musculoskeletal Function Assessment (SMFA), and quality of life was assessed by the EQoL-5D-5L. Results. There were no significant differences in the mean values characterizing age, severity of limb injury and number of surgeries prior to hospitalization. Outcomes were assessed in all patients in terms from 1 to 10 years. Patients who underwent Syme’s operation had significantly better mean scores on the applied scoring systems compared to patients who underwent TTA. The mean value of standardized disability index (SMFA) in patients of group I was 0.13 vs 0.22 in patients of group II (p = 0.006; two-sample t-test). The quality of life of the injured in group I, according to EQoL-5D-5L (VAS), was better than that in patients of group II (83.6 and 75.4 respectively, p = 0.04; two-sample t-test) due to the mobility, activity, anxiety/depression segments (p = 0.02; 0.04; 0.01, respectively; two-sample t-test). Conclusions. Syme’s operation provides a better functional outcome according to SMFA and a better quality of life according to EQoL-5D-5L than TTA. This makes it possible to use Syme’s operation more widely in patients with gunshot injuries of the lower limb in indicated cases.