This article is more than 5 years old. Information may no longer be current.
Good function, but significant foot and ankle pain seen after tibial shaft fractures
Study produced first long-term outcome data tibial shaft fractures treated with modern techniques.
Click Here to Manage Email Alerts
CHICAGO — Prospective study results showed that patient age and fracture severity significantly influence long-term outcomes of tibial shaft fractures that are treated with modern treatment methods.
“This is the largest and longest study of tibial shaft fractures treated by modern methods,” Leela C. Biant, FRCS (Ortho), trauma consultant and orthopaedic surgeon atThe Royal Infirmary of Edinburgh, in Edinburgh, United Kingdom, said at the American Academy of Orthopaedic Surgeons Annual Meeting, here.
Biant and colleagues established a database of 1,502 consecutive patients with tibial shaft fractures treated at a high-volume trauma unit from 1990 to 1999. Some patients were excluded, 389 patients were deceased and others lost to follow-up, which left 568 patients with 579 fractures available for the complete study. They were assessed at a mean follow-up of 17 years.
Fractures related to age
The mean age of patients at the time of fracture was 40 years (range: 40 years to 88 years).
“This is a fracture of young men and old women,” Biant said. “The old women are on the increase, I’m afraid.”
Biant and colleagues classified the fractures they included in the study with the AO and Gustilo-Anderson classification systems. In all, 63% of patients had type A fractures, and 20% were open fractures, Biant said.
This AP radiograph shows a classic tibial shaft fracture that investigators treated with modern methods and followed up long-term.
Image: Biant LC
The investigators recorded time to union, complication rate, hardware removal and incidence of anterior knee pain and ankle pain for the fractures. In addition, the researchers assessed how the injury affected the patient’s employment and the effect that social deprivation had on outcomes.
Based on the results, 90% of fractures healed after the first intervention or conservative treatment. Most patients returned to the same type of employment, and 7% had a disability related to the fracture at long-term follow-up, Biant said.
Socioeconomic status and outcome
Previous research showed a link between social deprivation or low socioeconomic status and a higher probability of sustaining certain fractures.
“We ran this analysis for tibial fractures and found that the incidence is higher in socially deprived patients, but the outcome in terms of pain and function is not statistically different to patients of higher socioeconomic means,” Biant told Orthopaedics Today Europe.
Eleven percent of patients underwent fasciotomy and this had no significant effect on long-term outcome.
“But most of these patients had routine compartment pressure monitoring, and fasciotomy was performed in a timely manner before development of significant muscle necrosis,” Biant said.
For elderly patients, the mortality associated with tibial shaft fractures was equivalent to that following a hip fracture, Biant said.
Knee and ankle pain may occur after tibial shaft fractures and are more common in severe injury, she said. – by Colleen Owens
- Reference:
- Biant LC. Paper #595. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 19-23, 2013; Chicago.
- For more information:
- Leela C. Biant, FRCS(Ortho), can be reached at The University of Edinburgh, The Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Rd., Edinburgh EH16 4SA, United Kingdom; email: leela.biant@nhslothian.scot.nhs.uk.
Disclosure: Biant is on the speaker’s bureau for Genzyme, is a paid consultant to Sanofi-Aventis and receives institutional/research support from Joint Replacement Instrumentation UK.