Abstract
Introduction
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.
Results
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.
Discussion
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: July 07, 2014
Accepted:
June 26,
2014
Identification
Copyright
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
