Complex tibial fractures are associated with lower social classes and predict early exit from employment and worse patient-reported QOL: a prospective observational study of 46 complex tibial fractures treated with a ring fixator

Abstract

The long-term outcomes following complex fractures of the tibia are reported to carry a risk of knee pain, malalignment, articular injury and post-traumatic osteoarthritis. The main objective of this study was to account for the patient-reported quality of life (QOL) 12 months after ring fixator removal in patients with a complex tibial fracture. Secondary objectives included a review of the socio-economic characteristics of the patient group and the rate of return to work in the study period. A prospective follow-up study was conducted of 60 patients with complex fractures of the tibia treated with ring external fixation. Patient-reported outcomes, radiological outcomes and socio-economic status including employment status of the patients were obtained 12 months after frame removal. Forty-six patients completed the assessment 12 months after frame removal (77%). The mean age of the patient at the time of fracture was 54.6 years (range 31–86). There were 19 males and 27 females. At 12 months after frame removal, the mean EQ5D-5L index was 0.66 (CI 0.60–0.72). The mean EQ5D-5L VAS was 69 (CI 61–76). When this was compared to the established reference population from Denmark, the study population showed a significantly worse EQ5D-5L index. The majority of patients (87%) were in the lower social classes suggesting a higher degree of social deprivation in the study population. Twenty-seven per cent of patients who were employed prior to injury had returned to employment at approximately 19 months following fracture. The onset of post-traumatic osteoarthritis was present in the knee joint in 29% of patients following a proximal intra-articular fracture, whereas osteoarthritis was present at the ankle joint in 35% of patients following a distal intra-articular fracture 12 months after frame removal. This study indicates that at 12 months after frame removal there are poorer patient-reported QOL as when compared to reference populations. Furthermore, this study suggests that complex tibial fractures are associated with lower social classes and that only 27% of patients in this sample, who prior to injury were employed, had returned to employment at approximately 19 months after the injury.

Factors influencing the outcome after surgical reconstruction of OTA type B and C tibial plateau fractures: how crucial is the restoration of articular congruity?

“…This is partly due to it being an uncommon, complex articular surface injury with very heterogenic fracture morphology and a high rate of accompanying soft tissue injuries, such as compartment syndrome and vascular, chondral, ligament and meniscal lesions [ 3 – 6 ]. Moreover, despite advances in diagnostics and surgical methods, high rates of posttraumatic osteoarthritis up to 40% [ 7 ] and large proportions with poor outcomes still remain [ 8 ], which could be due to an incongruent restoration after osteosynthesis. This is particular important since optimum restoration of the joint surface and articular congruity seems to be decisive for achieving satisfactory clinical results [ 7 , 9 , 10 ].…”

The Role of Circular Frames in the Management of Tibial Fractures

“…Over 66% of patients felt that this injury was still affecting their lifestyle, despite the fact that the mean time of review after the injury was 4.6 years. Elsoe et al found that only 27% of patients with tibial fractures had returned to employment 18 months after injury [ 10 ]. Volgas et al reported that 37% of patients had to sell possessions to meet financial obligations after their injuries [ 11 ].…”

Multimodal analgesia is superior to opiates alone after tibial fracture in patients with substance abuse history

“…[2] Operative treatment is dependent on the severity of the fracture and can include internal and/or external fixation and staged treatment plans in fractures where there is significant deformity. [3] The preferred operative treatment is intramedullary nailing [4] where osseous union, length, and alignment are reproducibly able to be achieved. [5] Tibial fractures are quite painful, but ineffective coping strategies and pain medication regimens can make the pain much more severe for the patient.…”