Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures

Abstract

A bstract Aim and objective The purpose of this study was to compare clinical results following complex proximal, midshaft, and distal tibial fractures and investigate whether there are differences in outcomes between these locations. Materials and methods Patients between 18 years and 65 years of age and minimum follow-up of 12 months with complex tibial fractures treated with a circular ring fixator were included. Functional outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) functional and bone scores, Foot Function Index (FFI), Four Step Square Test (FSST), and Timed Up and Go Test (TUG). Quality of life was assessed by the EQ-5D score. Results A total of 45 patients were included: proximal fractures, n = 11; midshaft fractures, n = 17; and distal fractures, n = 17. ASAMI functional ( p = 0.8) and bone scores ( p = 0.3) were not different. Excellent and good bone scores were achieved in >90% in all groups. FFI was 30.9 + 24.7 in the proximal group, 33.9 + 27.7 in the midshaft group, and 28.8 + 26.9 in the distal group ( p = 0.8). TUG was 9.0 + 2.7 sec in the proximal group, 9.0+3.5 in the midshaft group, and 8.5+2.0 in the distal group ( p = 0.67). FSST was 10.7 + 2.5 sec in the proximal, 10.3 + 3.8 in the midshaft, and 8.9 + 1.8 in the distal fracture groups ( p = 0.5). EQ-5D index value was highest in the distal (0.72), lowest in the proximal (0.55), and 0.70 in the midshaft fracture groups ( p = 0.001). EQ-5D VAS was significantly different between the proximal (65) and midshaft (82.3) ( p = 0.001) and between the distal (75) and proximal (65) fracture groups ( p = 0.001). Conclusions The results of this study suggest that the functional outcomes between proximal, midshaft, and distal complex tibial fractures are comparable. Their ability to ambulate afterward is comparable to age-related normative data, but complex tasks are more difficult and better compared to the ambulating ability of a healthy population aged 65 to 80 years. Patients with proximal tibial fractures had significantly more disability by at least one functional level and/or one health dimension. How to cite this article Naude JJ, Manjra MA, Birkholtz F, et al. Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures. Strategies Trauma Limb Reconstr 2021;16(1):32–40.

Manejo Integral de Fractura Expuesta de Tibia Proximal. Reporte de Caso

“…Este tipo de fracturas son un desafío para el equipo médico y para el paciente, este último suele subestimar la lesión, pese a que las investigaciones han demostrado que la fractura de tibia proximal comparada con las fracturas de tibia medial y distal se asocian a mayor dolor residual, mayores limitaciones funcionales y osteoartritis (12) (13).…”

A Review of Tibial Shaft Fracture Fixation Methods

“…Multiple circular constructs, using a combination of wires and half pins, have been used with success [62]. These constructs provide high axial, bending, and rotational stiffness, resulting in axial micromotion which favors bone healing [62].…”

“…Multiple circular constructs, using a combination of wires and half pins, have been used with success [62]. These constructs provide high axial, bending, and rotational stiffness, resulting in axial micromotion which favors bone healing [62]. The hexapod external fixator is a multiplanar fixator consisting of two rings or partial rings connected by six telescopic struts at universal joints, allowing versatility of spatial deformity correction [51,63,64].…”

“…The hexapod external fixator is a multiplanar fixator consisting of two rings or partial rings connected by six telescopic struts at universal joints, allowing versatility of spatial deformity correction [51,63,64]. Adjusting the struts within six degrees of freedom, either acutely or gradually, allows for fracture reduction, correction of angulation, rotation, and translation, as well as leg lengthening [62]. In a study of 34 high-energy tibial shaft fractures treated with a hexapod external fixator, every patient achieved complete bone union and satisfactory alignment and were able to perform activities of daily living [51,55].…”

Functional outcomes and quality of life after surgically treated tibial plateau fractures

“…Also, several studies which evaluated functional outcomes and quality of life (QoL) after TPF and OA have reported unsatisfactory results [ 23 , 24 ]. Moreover, the proximal tibia fractures resulted in worse outcomes than outcomes of midshaft or distal tibial fractures [ 25 ]. However, to the best of our knowledge, no study compared the results of their evaluation against a matched control group.…”