Session III - Femur
Thirty-four Year Follow-up of Femur Fractures from the Vietnam War
LTC Paul J. Dougherty, MD1; COL Raymond Bagg, MD2;
Purpose: A high rate of morbidity and disability accompanies femur fractures sustained during battle. The long-term outcome regarding employment and family life of young patients with femur fractures is unclear. To our knowledge, no long-term studies have evaluated the effects of a femur fracture on potential long-term problems such as the presence of chronic osteomyelitis, limp, and hip and knee pain. The purpose of this study was to evaluate the outcome of patients with this injury through questionnaires and the SF-36 Health Survey.
Methods: Patients with a diagnosis of femur fracture (OTA classification 32) were identified from archives of the 106th General Hospital from 1966 to 1969 (Vietnam War era), and their records were reviewed. Of 197 living patients, 118 were contacted via telephone or by mail. Contacted subjects were asked to respond to a questionnaire and SF-36 Health survey. Patients were queried about their medical care, other major injuries, long-term osteomyelitis, leg-length discrepancy, use of shoe lifts, joint pain, hip or knee replacement, use of psychological support services, marriage and employment status. The SF-36 Health Survey was administered to ascertain the patients' perceived health status. A Student's t-test was used to compare scaled scores of the SF-36 with published norms matched for age and gender.
Results: Of the 118 patients who were contacted, 68 (58%) agreed to answer the survey. Average years to follow-up were 34.2 (range, 33 to 36), and average age at follow-up was 55.6 years (range, 52 to 62). The mechanism of injury was gunshot for 39 of 68 patients (58%), rocket for 8 of 68 (12%), land mine for 7 of 68 (10%), and fragments from explosive munitions (mortar, grenade, and other) for the remaining 14. Other injuries occurred in 37 of 68 patients (54%) to include injuries to the head or face of 3, chest of 1, abdomen of 4, another major long bone fracture of 13, major nerve injury of 10, amputation of 3, vascular injury of 2, and paraplegia of 1. Patients had an average of 3.7 (range 1 to 12) operations for the femur fracture and were treated by a combination of skeletal traction, casting, and cast brace in 58 patients (85%). Ten (14.7%) were treated by use of an intramedullary nail. Ten (14.7%) reported chronic osteomyelitis of the femur, and a further two report chronic traction pin osteomyelitis. Of 51 patients (75%) reporting leg length discrepancy, 28 reported the use of shoe lifts. Forty-one of 61 (68%) reported hip pain, and 48 of 61 (78.6%) reported knee pain. Four patients of 60 reported total joint arthroplasty or fusion for the hip or knee. Fifty-one of 60 respondents (85%) reported working a mean of 23.6 years (SD ± 10.7) after leaving the military. Nine patients never worked after their injury. Fifty-seven of 60 respondents (95%) reported that they are or were married a mean of 25.8 years (SD ± 10.9), with 16 (28%) divorced one or more times at the time of follow-up. Posttraumatic stress disorder was reported by seven patients, and "neurosis" by one. Compared with age- and gender-matched controls, these patients with femur fractures scored significantly lower in all areas of the SF-36 (P <0.05).
Conclusion/Significance: Soldiers who sustain femur fractures during war often have associated injuries. The SF-36 scores suggested a significant disability for those who sustained combat-incurred femur fractures. Despite lower SF-36 scores, most patients were able to lead relatively successful lives with regard to employment and family life.