Time Trade-Off as a Measure of Health-Related Quality of Life: Long Bone Nonunions Have a Devastating Impact.
BACKGROUND
Long bone nonunions have an important impact on a patient's quality of life. The purpose of this study was to compare long bone nonunions with use of the Time Trade-Off direct measure to compute utility scores and to determine which nonunion anatomic location had the lowest health-related quality of life. The Time Trade-Off assesses the percentage of a patient's remaining life that the patient would be willing to trade for perfect health.


METHODS
Eight hundred and thirty-two consecutive long bone nonunions with Time Trade-Off data were identified and were retrospectively studied from a prospectively collected patient database. Nonunions with infections and those involving the articular portion of the bone were recorded. Time Trade-Off utility scores were obtained for all nonunion cases upon their initial clinical evaluation by a single surgeon specializing in reconstructive trauma.


RESULTS
The mean utility score of our nonunion cohort was 0.68 and it differed significantly by long bone (p = 0.037). Nonunions of the forearm had the lowest utility score (0.54), followed by the clavicle (0.59), femur (0.68), tibia or fibula (0.68), and humerus (0.71). Post hoc tests showed that patients with nonunions of the forearm had significantly lower utility scores (p = 0.031) compared with all other bones.


CONCLUSIONS
Patients diagnosed with a long bone nonunion have a very low health-related quality of life. We found that this single cohort's mean utility score was 0.68. This result is well below that of illnesses such as type-I diabetes mellitus (0.88), stroke (0.81), and acquired immunodeficiency syndrome (0.79). We found that patients with forearm nonunions had the lowest utility scores.


METHODS
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, 6400 Fannin Street, Suite 1700, Houston, TX 77030.
Patrick C
PC
Schottel
Health and Human Performance, University of Houston, 3855 Holman, GAR104, Houston, TX 77204-6015. E-mail address: doconnor2@uh.edu.
Daniel P
DP
O'Connor
Center for Problem Fractures and Limb Restoration, Fondren Orthopedic Group, Texas Orthopedic Hospital, 7401 South Main Street, Houston, TX 77030.
Mark R
MR
Brinker
D000368:Aged; D000704:Analysis of Variance; D050280:Arm Bones / Q000293:injuries* / Q000601:surgery; D001850:Bone Diseases, Infectious / Q000209:etiology; D005260:Female; D005599:Fractures, Ununited / Q000523:psychology*; D006801:Humans; D007867:Leg Bones / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome