title: The impact of injuries below the knee joint on the long-term functional outcome following polytrauma.
abstract: Previous studies have suggested that the lower-extremities are among the most frequently injured body regions in polytrauma patients and have a major impact on the functional recovery following polytrauma. In particular, injuries to the distal part of the lower-extremity appear to be associated with a poor functional outcome. Therefore, the goal of this study was to evaluate the impact of injuries below the knee joint on the long-term functional outcome following polytrauma. Three hundred eighty-nine polytrauma patients with associated lower-extremity fractures and a minimum follow-up of 10 years were included in this study. All patients were examined by a doctor, using a patient questionnaire and a standardised physical examination. Significantly, inferior outcomes were seen in patients with fractures below the knee joint as measured by the modified Karlström-Olerud score, Lysholm score, range of motion, weight bearing status, Hannover score for polytrauma outcome (HASPOC), SF-12, Tegner activity score, and inability to work (P < 0.05). Fractures below the knee joint have a significant impact on the functional recovery following polytrauma. We suggest that delayed treatment, thin soft tissue envelope below the knee joint, high-energy trauma, unfavorable blood supply, and complex fracture patterns contribute to these unfavorable outcomes.
authors.affiliation: Department of Trauma Surgery, Hannover Medical School, Hannover, Germany. zelleba@upmc.edu
authors.forename: B A
authors.initials: BA
authors.lastname: Zelle
authors.forename: S R
authors.initials: SR
authors.lastname: Brown
authors.forename: M
authors.initials: M
authors.lastname: Panzica
authors.forename: R
authors.initials: R
authors.lastname: Lohse
authors.forename: N A
authors.initials: NA
authors.lastname: Sittaro
authors.forename: C
authors.initials: C
authors.lastname: Krettek
authors.forename: H C
authors.initials: HC
authors.lastname: Pape
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000601:surgery*; D005684:Gait / Q000502:physiology; D006801:Humans; D007719:Knee Joint; D007869:Leg Injuries / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D009104:Multiple Trauma / Q000473:pathology / Q000503:physiopathology*; D016017:Odds Ratio; D010147:Pain Measurement; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology