title: Outcome at 12 to 22 years of 1502 tibial shaft fractures.
abstract: Fractures of the tibial shaft are common injuries, but there are no long-term outcome data in the era of increased surgical management. The aim of this prospective study was to assess the clinical and functional outcome of this injury at 12 to 22 years. Secondary aims were to determine the short- and long-term mortality, and if there were any predictors of clinical or functional outcome or mortality. From a prospective trauma database of 1502 tibial shaft fractures in 1474 consecutive adult patients, we identified a cohort of 1431 tibial diaphyseal fractures in 1403 patients, who fitted our inclusion criteria. There were 1024 men, and mean age at injury was 40.6 years. Fractures were classified according to the AO system, and open fractures graded after Gustilo and Anderson. Requirement of fasciotomy, time to fracture union, complications, incidence of knee and ankle pain at long-term follow-up, changes in employment and the patients' social deprivation status were recorded. Function was assessed at 12 to 22 years post-injury using the Short Musculoskeletal Function Assessment and short form-12 questionnaires. Long-term functional outcome data was available for 568 of the surviving patients, 389 were deceased and 346 were lost to follow-up. Most fractures (90.7%, n = 1363) united without further intervention. Fasciotomies were performed in 11.5% of patients; this did not correlate with poorer functional outcome in the long term. Social deprivation was associated with a higher incidence of injury but had no impact on long-term function. The one-year mortality in those over 75 years of age was 29 (42%). At long-term follow-up, pain and function scores were good. However, 147 (26%) reported ongoing knee pain, 62 (10%) reported ankle pain and 97 (17%) reported both. Such joint pain correlated with poorer functional outcome.
authors.affiliation: Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: C L
authors.initials: CL
authors.lastname: Connelly
authors.affiliation: Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: V
authors.initials: V
authors.lastname: Bucknall
authors.affiliation: Glasgow Royal Infirmary, Department of Orthopaedic Surgery, 84 Castle Street, Glasgow, G4 0SF.
authors.forename: P J
authors.initials: PJ
authors.lastname: Jenkins
authors.affiliation: Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Court-Brown
authors.affiliation: Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: McQueen
authors.affiliation: Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, Old Dalkeith Road, Edinburgh, EH16 4SA, UK.
authors.forename: L C
authors.initials: LC
authors.lastname: Biant
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint; D018771:Arthralgia / Q000453:epidemiology; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016268:Internal Fixators; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013978:Tibial Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Fasciotomy; Long-term outcome; Mortality; Open fracture; Tibial fracture