title: The devastating effects of tibial nonunion on health-related quality of life.
abstract: BACKGROUND
  Tibial nonunion is disabling, but to our knowledge no quantitative evaluation of its effect on health-related quality of life has been reported.
  
  
  METHODS
  We evaluated 243 tibial shaft fracture nonunions in 237 consecutive patients (seventy-nine female [age, 49.4 ± 14.9 years] and 158 male [age, 46.3 ± 15.4 years]) who were referred to a single surgeon at our tertiary care center over a ten-year period. The most frequently affected tibial segment was the distal third (49%), and infection was present in 18% of all cases.
  
  
  RESULTS
  The Short Form (SF)-12 Physical Component Summary score averaged 27.4 ± 6.7, indicating an extremely disabling effect on physical health. The AAOS (American Academy or Orthopaedic Surgeons) Lower Limb Core Scale score averaged 52.0 ± 19.4, also consistent with high levels of physical disability attributable to the lower limb. The SF-12 Mental Component Summary score averaged 42.3 ± 7.1, indicating a substantial detrimental effect on mental health.
  
  
  CONCLUSIONS
  The impact of tibial shaft fracture nonunion on physical health was comparable with the reported impact of end-stage hip arthrosis and worse than that of congestive heart failure. Tibial shaft fracture nonunion is a devastating chronic medical condition that negatively affects both physical and mental health and quality of life.
authors.affiliation: Fondren Orthopedic Group, Center for Problem Fractures and Limb Restoration, Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Brinker
authors.affiliation: Department of Surgery, Vanderbilt University School of Medicine, D-4314 Medical Center North, Nashville, TN 37232.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Hanus
authors.affiliation: Department of Orthopaedic Surgery, University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX 77030.
authors.forename: Milan
authors.initials: M
authors.lastname: Sen
authors.affiliation: Laboratory of Integrated Physiology, University of Houston, 3855 Holman Street, GAR104, Houston, TX 77204-6015. E-mail address: doconnor2@uh.edu.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005599:Fractures, Ununited / Q000523:psychology* / Q000601:surgery; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D013978:Tibial Fractures / Q000523:psychology* / Q000601:surgery