Session III - Polytrauma Fracture Healing

*Objective and Subjective Outcome 2 Years after Polytrauma: An Investigation by the German Trauma Registry

Hans C. Pape, MD (a-DFG-German Society for Research); M. Stalp, MD (a-DFG-German Society for Research); N. Pirente, PhD (a-DFG-German Society for Research); E. Neugebauer, MD (a-DFG-German Society for Research); Harald Tscherne, MD (a-DFG-German Society for Research), Hannover Medical School, Hannover, Germany

Purpose: Adequate quality of life in patients late after severe blunt trauma represents a major goal. Most previous investigations regarding this issue relied only on subjective (patient interrogation) or objective (clinical exam) data. We have begun a multi-center reexamination for all multiple trauma patients in 5 trauma centers. Both objective and subjective data were obtained by a physician's clinical examination and by a thorough inquiry of the patient's subjective complaints in order to assess whether these data coincide.

Methods: Two years after the initial injury, all patients were reinvited for an outpatient evaluation. The clinical exam was performed by an experienced surgeon and included a complete assessment of the musculosceletal system including a neurologic examination. Subjective quality of life was determined by SF-36 test (short form 36) (I: excellent - VI: bad) and by MFA (Musc. Function Assessment, University of Washington).

Results: 254 out of 312 patients, who had been injured between 1/1995 and 7/1996, were reexamined between 1.1.1997 and 1.7.1998. Mean age 36±13 years, mean injury severity 24±6 points (ISS), mean initial Glasgow coma scale 11±4 points. AIS_head3.3±1.1, AIS_Face 1.4±0.1, AIS_Thorax3.0±0.8, AIS_Abdomen, 1.7±0.6, AIS_Extr. 3.4±0.8.

General subjective outcome (SF-36): I 9%, II 25%, III 29%, IV 25%, V 6%, VI 6%. Subjective outcome of the injured extremity: Moderate or severe restrictions according to the MFA were present in 41% of injuries of the lower and in 16% of the upper extremity. In the lower extremity, in 52% subjective pain or impaired ability to ambulate was related to the foot and ankle, 31% to the knee or thigh, and 27% to the femur or hip.

Range of motion (neutral-0 method as percentage of nl range of the injured extremity):

Neutral-0 (%)	0-20	20-50	>50
Shoulder (%)	11.7	13.5	74.8
Elbow (%)	5.4	18.0	77.0
Wrist (%)	10.8	12.6	77.9
Hip	7.0	16.2	75.4
Knee	3.9	8.4	87.7
Ankle	13.4	20.7	65.9

Conclusion: In a standardized multi-center reexamination of patients with blunt multiple trauma, the general subjective outcome was usually fair or good. Both the subjective complaints and the objective results of specific extremity areas demonstrate that most limitations were due to injuries below the knee.