OTA 1997 Posters - Tibia Fractures

A Prospective Study of General Health Status following Ilizarov Reconstruction of Post-Traumatic Lower Extremity Deformity

Michael D. McKee, MD, FRCS(C), Daniel Yoo, Emil H. Schemitsch, MD, FRCS(C)

St. Michael's Hospital, Univ. of Toronto, Toronto, Ontario, Canada

Purpose: Previous studies of the Ilizarov procedure have used bone or joint-specific outcome measures, with little emphasis on patient-oriented outcome measures. In a prospective trial, we sought to determine the effect of Ilizarov reconstruction on functional outcome and general health status.

Conclusion: Ilizarov reconstruction of post-traumatic deformity reliably restores bony anatomy and alignment and also produces a gratifying improvement in the general health status of patients. Improvements in health status scores following Ilizarov reconstruction are equal or superior to results reported for other orthopaedic interventions, including total joint arthroplasty, and are not limited to "physical" components only. This study supports the use of the llizarov method for complex post-traumatic deformities.

Summary of Method, Results And Discussion: Twenty-five consecutive patients who underwent Ilizarov reconstruction of a post traumatic lower extremity deformity by a single surgeon were entered in a prospective trial. All patients completed two patient-oriented general health status questionnaires (the SF-36 and the Nottingham Health Profile) prior to their Ilizarov reconstruction (pre-op), while in the Ilizarov frame (in frame) and post-operatively (postop). Of the 25 patients, 2 underwent amputation, 1 was lost to follow up and the remaining 22 were followed to definitive outcome (avg. follow up post frame removal 9.2 months, range 6-24 months). There were 12 males and 10 females, mean age 39.8 years. The Ilizarov procedure was performed a mean of 28.7 months after the initial injury, after a mean of 4.3 prior operative procedures (range 2-14). Fourteen patients had a leg length discrepancy or bony defect (mean 6.1 cm), and twelve patients had angular or rotational deformities (mean 31 degrees). Mean time in the frame was 9.8 months. According to the Association for the Study and Application of the Methods of Ilizarov criteria, there were 9 excellent, 8 good, 3 fair, and 2 poor "bone" results. The severity of disability experienced by these patients was illustrated by very low preoperative SF-36 and NHP scores. Scores remained poor while patients were undergoing correction (in frame), but dramatic increases were seen in post-operative values. Significant improvements between preoperative and postoperative SF-36 values were seen in general health perceptions (35.7 to 57.7, p=0.02), pain index (37.6 to 62.6, p=0.006), mental health (36.0 to 69.5, p=0.0002) and emotional role function (39.2 to 75.8, p=0.01). NHP scores demonstrated similar increases, including mental component scale (33.6 to 50.4, p=0.0001), pain (33.3 to 60.5, p=0.05), sleep patterns (30.8 to 68.5, p=0.005) and overall mean (38.8 to 67. 1, p=0.002).