Outcomes of isolated tibial shaft fractures treated at level 1 trauma centres

Summary Background Although most tibial shaft fractures are expected to heal within 24 weeks, the long-term effects of these injuries on patients in terms of self-reported health status, disability, and pain are largely unknown. Objectives To investigate the clinical and patient-reported outcomes of patients with isolated tibial shaft fractures treated at the two level 1 adult trauma centres in Victoria, Australia. Methods Sixty patients with isolated tibial shaft fractures treated at the Royal Melbourne Hospital and the Alfred Hospital between August 2003 and August 2004 were identified via the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Patient-reported outcomes were prospectively measured 1 year post-injury using the 12-Item Short-Form Health Survey (SF-12) (also administered at baseline); the Work subscale of the Sickness Impact Profile; and a Numerical Rating Scale for pain. A priori defined clinical outcomes were also determined by retrospectively reviewing hospital medical records and X-rays. Results Full weight-bearing status was achieved after a median inter quartile range (IQR) time of 14.0 (12.5–20.0) weeks, and the median (IQR) time to radiological union was 35.8 (23.3–51.6) weeks. Sixty percent of patients completed the SF-12 at both baseline and 12 months post-injury. Although there were no clear changes in mental health scores (median change = +1.0; IQR = −3.5 to 4.0; p = 0.52), physical health scores were significantly reduced (median change = −3.0; IQR = −19.5 to 0.3; p = 0.003). Additionally, 47% of patients reported work-related disability and 40% experienced persistent pain 1 year post-injury. Conclusions These results indicate that long-term physical disability remains a problem for many patients following tibial shaft fracture, and they should be considered when providing prognostic information to patients. Further research is required to identify the specific health problems experienced as well as the factors contributing to disability in order to inform post-fracture rehabilitation planning.