Proximal tibial metaphyseal fractures with severe soft tissue injury: clinical and functional results at 2 years.
BACKGROUND
Controversy exists regarding management of proximal tibial metaphyseal fractures with severe soft tissue injury. It is unclear whether limb salvage or early amputation results in the best functional and clinical outcomes.


OBJECTIVE
We hypothesized that in this group of patients, there is no difference in functional outcomes, complication rates, clinical outcomes, or objective physical function related to the treatment approach.


METHODS
We used the LEAP study database to perform a retrospective comparative review of a subset of patients with proximal tibial metaphyseal fractures (AO/OTA 41A, B, and C) with associated severe soft tissue injuries comparing the outcomes of patients who were treated with either limb salvage or amputation.


RESULTS
Although there were major differences in clinical and functional outcomes based on patients' sociodemographics at 2 years, no differences in clinical or functional outcomes were detected regardless of whether amputation or limb salvage was performed. Severity of soft tissue injury was more predictive of outcome than the surgical approach used.


CONCLUSIONS
Sociodemographics and soft tissue injury severity are more important than treatment approach for predicting clinical and functional outcomes at 2 years in patients with proximal tibia metaphyseal fractures with severe soft tissue injury.


METHODS
Level III, retrospective comparative study. See Guidelines for Authors for a complete description of levels of evidence.
Starman
James S
JS
Department of Orthopaedic Surgery, Carolinas Medical Center, 1616 Scott Avenue, Charlotte, NC, 28203, USA, jstarman20@msn.com.
Castillo
Renan C
RC
Bosse
Michael J
MJ
MacKenzie
Ellen J
EJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D018582:Sick Leave; D018434:Sickness Impact Profile; D017695:Soft Tissue Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013978:Tibial Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult