Knowledge about the functional consequences of lower limb long bone fractures is helpful to inform patients, clinicians and employers about their recovery process and prognosis. This study aims to describe the epidemiology and health outcomes of femoral and tibial shaft fractures treated at two level I trauma centres, by comparing the differences between patients with delayed union or nonunion and patients with union.
Patients and methods
An analysis of registry data over two years, supplemented with medical record review, was conducted. Fracture healing was retrospectively assessed by clinical and radiological evidence of union, and the need for surgical intervention. SF-12 scores, and work and pain status were prospectively recorded at six and twelve months post injury.
285 fractures progressed to union and 138 fractures developed delayed union or nonunion. There was a significant difference between the two cohorts with regards to the mechanism of injury, association with multi-trauma, open fractures, grade of Gustilo classification, patient fund source, smoking status and presence of comorbidities. The SF-12 physical component score was less than 50 at both six and twelve months with improvement in the union group, but not in the delayed union or nonunion group. 72% of patients with union had returned to work at one year, but 54% continued to have pain. The difference compared to patients with delayed union or nonunion was significant.
Even patients whose fractures unite in the expectant time-frame will have residual physical disability. Patients with delayed union or nonunion have still poorer outcomes, including ongoing problems with returning to work and pain. It is important to educate patients about their injury so that they have realistic expectations. This is particularly relevant given that the patients most likely to sustain femoral or tibial shaft fractures are working-age healthy adults, and up to a third of fractures may develop delayed union or nonunion.
Despite modern treatment, the patient-reported outcomes of lower limb long bone shaft fractures do not return to normal at one year. Patients with delayed union or nonunion can expect poorer outcomes.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Injury
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Fractures of the lower extremity.in: 12th ed. Canale & Beaty: Campbell's operative orthopaedics. vol. III. Mosby, Philadelphia2013 (Ch. 54)
- Delayed union and nonunion of fractures.in: 12th ed. Canale & Beaty: Campbell's operative orthopaedics. vol. III. Mosby, Philadelphia2013 (Ch. 59)
- Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation.Clin Orthopaed Relat Res. 1993; 295: 28-36
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- The SF-36 health survey: manual and interpretation guide.The Health Institute, Boston1993
- The health economics of the treatment of long-bone non-unions.Injury. 2007; 38: 77-84
- Nonunion of the diaphysis of long bones.Clin Orthopaed Relat Res. 2005; 431: 50-56
- Functional outcome after treatment of lower-extremity nonunions.J Trauma. 2005; 58: 312-317
- The impact of spinal problems on the health status of patients. Have we underestimated the effect?.Spine. 2000; 25: 1509-1514
- SF-36 general health status survey to determine patient satisfaction at short-term follow-up after total hip and knee arthroplasty.J South Orthop Assoc. 1997; 6: 169-172
- Outcome after pelvic ring fractures: evaluation using the Medical Outcomes Short Form SF-36.Injury. 1996; 27: 635-641
- Victorian Orthopaedic Trauma Outcomes Registry: evaluation and monitoring of orthopaedic trauma management across Victorian hospitals.Monash University, Melbourne2006
- Outcome assessment in clinical trials of fracture-healing.J Bone Joint Surg. 2008; 90 (American): 62-67
- Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation.J Bone Joint Surg. 2002; 84B (British): 15-18
- The reliability and internal consistency of an internet-capable computer program for measuring utilities.Qual Life Res. 2000; 9: 811-817
- Simplified scoring and psychometrics of the revised 12-Item Short-Form Health Survey.Outcomes Manag Nurs Pract. 2001; 5: 161-166
- Reliability and validity of the SF-12 health survey among people with severe mental illness.Med Care. 2000; 38: 1141-1150
- A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233
- The SF-12 in the Australian population: cross-validation of item selection.Aust N Z J Public Health. 2002; 26: 343-345
- Correlation of SF-12 and SF-36 in a trauma population.J Surg Res. 2006; 132: 214-218
- SF-12: How to score the SF-12 Physical and Mental Health Summary scales.3rd ed. QualityMetric, Lincoln1998
- Quality of life in South Australia as measured by the SF12 health status questionnaire: population norms for 2003, trends from 1997–2003.South Australian Department of Human Services, Adelaide2004
- Validation of a combined comorbidity index.J Clin Epidemiol. 1994; 47: 1245-1251
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chron Dis. 1987; 40: 373-383
- Stata Release 13.StataCorp LP, College Station, TX, USA2013
- Outcome after intramedullary nailing of femoral shaft fractures.Aust N Z J Surg. 2003; 73: 387-389
- Reoperation rate in diaphyseal tibia fractures.Aust N Z J Surg. 2005; 75: 1041-1044
- Late outcome of isolated tibial fractures treated by intramedullary nailing: the correlation between disease-specific and generic outcome measures.J Orthopaed Trauma. 2002; 16: 245-249
- The effect of head injury on fracture healing. A quantitative assessment.J Bone Joint Surg. 1987; 69B (British): 525-528
- A lack of consensus in the assessment of fracture healing among orthopaedic surgeons.J Orthopaed Trauma. 2002; 16: 562-566
- Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures.J Bone Joint Surg. 2008; 90 (American): 2567-2578
- One-year outcome after tibial shaft fractures: results of a prospective fracture registry.J Orthop Trauma. 2001; 15: 210-215
- Outcome validation of the AO/OTA fracture classification system.J Orthopaed Trauma. 2000; 14: 534-541
Published online: July 07, 2014
Accepted: June 26, 2014
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.