The incidence of chronic pain following tibial diaphyseal fracture.

Abstract

Patients presenting to a London Major Trauma Centre between 01/01/2016-31/12/2016 with fractures of the tibial diaphysis were retrospectively identified using 'eTrauma' (OpenMedical, London, UK), a digital trauma management system. Cases were validated against the hospitals Electronic Health Record (Cerner Corporation, North Kansas City, USA) and submissions to the Trauma Audit and Research Network (TARN) database. Data collection was done at St Mary's hospital 01/04/2017-30/06/2017. Patient demographic information, injury mechanism, fracture morphology, pain Introduction: Chronic pain affects up to 40% of patients at 7 years after tibial fracture impacting on their quality of life (QoL) and ability to participate in activities of daily living. Major nerves run in close proximity to the tibia and are prone to injury during tibial fracture. Nerve injury can cause acute neuropathic pain, which responds poorly to commonly prescribed analgesics and predisposes patients to developing chronic pain. This study aims to describe the incidence and impact of pain at 6-12 months after tibial fractures. Methods: Patients admitted to a major trauma centre between 01/01/2016-31/12/2016 with isolated tibial fractures were identified using prospectively recorded database eTrauma. Injuries were categorized using the AO classification. Pain and Quality of Life at 6-12 months post injury were assessed using the EuroQol (EQ-5D-5L) questionnaire and the Douleur Neuropathique 4 questionnaire for neuropathic pain. Results: Forty isolated tibial fractures were identified and 20 were followed up. Pain was reported by 18 (90%) of patients. Ten (50%) reported moderate to severe pain, with median pain scores of 2.6/5. Pain scores were significantly greater following high-energy injuries however no significant links were seen between pain and other patient, injury or management factors. Conclusion: Chronic pain is common following tibial fracture and is largely under-reported. Further prospective multi-center investigation is warranted to better identify those with neuropathic pain and other risk factors for chronic pain. This could guide effective management and improve patient outcomes