OTA 1997 Posters - Tibia Fractures

Functional Outcome after Tibial Shaft Fractures - A 4 Year Follow-Up Study

Manuel F. DaSilva, MD, Robert B. Koch, MD, Lynn Voss, MD, Winslow Alford, BA, Peter G. Trafton, MD

Brown University, Providence, Rhode Island, USA

Hypothesis: There is a lack of information regarding persistent functional limitations after tibial shaft fractures. This project evaluates and documents the long term functional outcome of this common injury by testing the following hypotheses: 1) Functional limitations continue long after the tibial shaft fracture is healed; 2) Functional limitations are fracture-type dependent.

Methods and Materials: Patients with tibia fractures were retrieved through a computer search of medical records confirmed by chart and x-ray review. After exclusion for incomplete original data, patients were called back for evaluation. The 68 patients remaining were the subjects of this study. They were evaluated an average of 4.3 years (range 4-5 years) after injury. Each patient was interviewed and examined by an examiner, who was previously uninvolved in their care. Each was questioned regarding their subjective assessment of treatment and recovery and completed an SF-36 form. A standardized, detailed physical examination assessed gait, deformity and function of the limb. Standing AP& Lat. radiographs of the involved tibia were obtained to determine the degrees of angulation, and shortening. The fractures were then classified according to OTA/AO and Ellis. Statistical analysis was done using SPSS and Systat software.

Results: Mean age was 38 years (range 17-92). There were 51 male and 17 females. Mechanism of injury involved vehicles in 36 patients; fall in 21; sports in 10 and industrial in 1. Thirty seven fractures were closed; 9 Grade I; 15 Grade II; and 7 Grade III A & B. Twenty-four were treated closed; 30 with IM; 13 with Ex fix; and 1 with a plate. Fractures were classified according to Ellis as minor (19), moderate (36), and major ( 13). At follow-up, 46% reported persistent reduction in walking distance, 17% had modified their work, 15% receive disability due to the fracture and 28% are unable to participate in their preferred recreational activities. Only 59% reported overall satisfaction. Subjective healing time for minor injuries was 9.6 months, 11.9 for moderate and 16.6 for major injuries. Overall satisfaction was unrelated to fracture type or treatment. However, there was a statistically significant negative correlation between both walking distance and ankle dorsiflexion and satisfaction (p <0.003, and p <0.026 respectively). There was no relation between the Ellis and OTA/AO classifications and the SF-36 scores. Patients with higher physical and social functioning scores in the SF-36 tended to be more satisfied (p<0.01 and p<0.03).

Conclusion: Functional limitations with significant subjective effects continue long after tibial shaft fractures are healed. They are not fracture-type dependent. Walking tolerance and ankle range of motion were particularly important.