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Decline in patient function prior to improvement after intramedullary nailing
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Patients treated with intramedullary nailing for tibial shaft fracture experienced a decline in function prior to improvement in function between 6 months and 12 months postoperatively, according to results.
“Historically, in the orthopedic literature the ‘end points’ of treatment have been arbitrary, related to radiographic healing and likely too early,” Kelly A. Lefaivre, BScH, MD, MSc (Epid), FRCSC, told Healio.com/Orthopedics. “Studies like ours highlight the realistic trajectory, and helps surgeons have clear discussions with patients about recovery timeline and post-injury deficits.”
At baseline and postoperatively at 6 months, 1 year and 5 years, Lefaivre and colleagues collected functional outcome data using the SF-36 and short musculoskeletal function assessment (SFMA) questionnaires for 132 patients (71% were men) with tibial shaft fractures treated acutely with intramedullary nailing (IM).
Results showed improvement in mean SF-36 physical component scores and mean SMFA dysfunction index scores between 6 months and 12 months and between 1 year and 5 years. Compared with scores between 6 months and 12 months, researchers noted scores between 1 year and 5 years had a flatter rate or slope of improvement. At 5-years postoperatively, SF-36 and SFMA scores did not reach baseline scores. Researchers found achievement of minimal clinically important difference among a significant proportion of patients between 1 year and 5 years.
According to Lefaivre, the results of this study may help in laying important “groundwork for planning timelines and outcomes for future studies in this area.”
“It is clear that tibia fractures treated with traditional IM nailing have some long-term deficits, and future studies may allow us to improve outcomes for these patients,” she said. – by Casey Tingle
Disclosure s : The researchers report no relevant financial disclosures.
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