Session II - Tibia
Fri., 10/8/04 Tibia, Paper #14, 11:45 am
Health-Related Quality of Life of Trauma Patients after the Full Spectrum of Tibial Injury (Fasciotomy, Closed Fracture, Grade IIIb/IIIc Open Fracture, and Amputation)
Purpose: Although isolated reports are available on quality of life of subjects after sustaining tibial trauma, no studies exist analyzing this measurement of outcome in the full spectrum of injury, from isolated compartment syndrome to severe injuries leading to amputation. In this study we aimed to quantify the health-related quality of life in a series of patients sustaining a variety of different tibial injuries.
Methods: Patients with previous tibial injury, randomly selected from our trauma database, who successfully completed their entire course of treatment at our institution, were recalled for final assessment. The EQ-5D (EuroQol) questionnaire, a standardized previously validated measure of health-related quality of life was used to assess functional outcome. The system scores patients' perceived problems based on five dimensions: anxiety/depression, pain/discomfort, usual activity, self-care, and mobility. It also includes a visual analog score (VAS) to assess overall level of function from 0 to 100% (100% being best). Mean time to final follow up was 37.4 months. Statistical analysis was performed with use of SPSS computer software.
Results: Overall, 130 patients were evaluated. Thirty-three patients with compartment syndrome requiring a fasciotomy (with no underlying fracture), represented the soft tissue element of these injuries. Thirty patients with closed diaphyseal tibial shaft fractures, who underwent intramedullary nailing, formed a group of moderately injured patients. Forty-five patients with grade IIIb and grade IIIc open fractures represented those with more severe trauma. Finally, 22 patients with the most severe injuries, requiring below-knee amputation (which was immediate in 60%), represented the most severe spectrum of these injuries. Patient demographics are shown in the table. There was no significant difference in the self-care dimension between the groups. Psychological problems were common in patients with IIIb and IIIc fractures, as well as amputees, with the highest incidence among those with IIIc fractures. Patients who had undergone amputation and those with IIIb open fractures reported problems with mobility significantly more frequently than those who had IIIc type injuries. However, this could be partially attributed to the significant difference in mean age between groups, with patients sustaining IIIc injuries being younger (31.9 vs. 46.9 years). Patients with IIIb and IIIc type fractures reported significantly more problems with pain compared with those who had undergone amputation. Interestingly, patients who had undergone fasciotomy reported pain as frequently as amputees. Regarding the VAS score, only patients with a closed fracture reported significantly different scores from the mean of all the other groups.
Patient Demographics (*P <0.05)
| Group | Amputee | Grade IIIb | Grade IIIc | Closed # | Fasciotomies |
| N | 22 |
30 |
15 |
30 |
33 |
| Age (mean) | 46.8* |
46.9* |
31.9* |
39.5 |
32.9 |
| Sex (m) | 17 |
23 |
12 |
23 |
29 |
| Mean ISS | 13.5 |
11.6 |
11.7 |
9.8 |
5.1 |
|
66 |
68 |
63 |
77* |
67 |
Conclusion/Significance: These data represent the health-related quality of life of patients who sustained the full spectrum of tibial injury and should be considered when determining the treatment options for these patients.