Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures

Jaco J Naude; Muhammad A Manjra; Franz Birkholtz; Annette-Christi Barnard; Kevin Tetsworth; Vaida Glatt; Erik Hohmann

doi:10.5005/jp-journals-10080-1506

Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures

Strategies Trauma Limb Reconstr. 2021 Jan-Apr;16(1):32-40. doi: 10.5005/jp-journals-10080-1506.

Authors

Jaco J Naude¹, Muhammad A Manjra¹, Franz Birkholtz¹, Annette-Christi Barnard², Kevin Tetsworth³, Vaida Glatt⁴, Erik Hohmann⁵

Affiliations

¹ Department of Orthopaedic Surgery, University of Pretoria, Pretoria, South Africa.
² Walk-A-Mile Centre for Advanced Orthopaedics, Centurion, South Africa.
³ Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Department of Surgery, School of Medicine, University of Queensland, Herston, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia; Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia.
⁴ University of Texas Health Science Center, San Antonio, Texas, USA.
⁵ School of Medicine, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates.

Abstract

Aim and objective: The purpose of this study was to compare clinical results following complex proximal, midshaft, and distal tibial fractures and investigate whether there are differences in outcomes between these locations.

Materials and methods: Patients between 18 years and 65 years of age and minimum follow-up of 12 months with complex tibial fractures treated with a circular ring fixator were included. Functional outcomes were assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) functional and bone scores, Foot Function Index (FFI), Four Step Square Test (FSST), and Timed Up and Go Test (TUG). Quality of life was assessed by the EQ-5D score.

Results: A total of 45 patients were included: proximal fractures, n = 11; midshaft fractures, n = 17; and distal fractures, n = 17. ASAMI functional (p = 0.8) and bone scores (p = 0.3) were not different. Excellent and good bone scores were achieved in >90% in all groups. FFI was 30.9 + 24.7 in the proximal group, 33.9 + 27.7 in the midshaft group, and 28.8 + 26.9 in the distal group (p = 0.8). TUG was 9.0 + 2.7 sec in the proximal group, 9.0+3.5 in the midshaft group, and 8.5+2.0 in the distal group (p = 0.67). FSST was 10.7 + 2.5 sec in the proximal, 10.3 + 3.8 in the midshaft, and 8.9 + 1.8 in the distal fracture groups (p = 0.5). EQ-5D index value was highest in the distal (0.72), lowest in the proximal (0.55), and 0.70 in the midshaft fracture groups (p = 0.001). EQ-5D VAS was significantly different between the proximal (65) and midshaft (82.3) (p = 0.001) and between the distal (75) and proximal (65) fracture groups (p = 0.001).

Conclusions: The results of this study suggest that the functional outcomes between proximal, midshaft, and distal complex tibial fractures are comparable. Their ability to ambulate afterward is comparable to age-related normative data, but complex tasks are more difficult and better compared to the ambulating ability of a healthy population aged 65 to 80 years. Patients with proximal tibial fractures had significantly more disability by at least one functional level and/or one health dimension.

How to cite this article: Naude JJ, Manjra MA, Birkholtz F, et al. Functional Outcomes and Quality of Life Following Complex Tibial Fractures Treated with Circular External Fixation: A Comparison between Proximal, Midshaft, and Distal Tibial Fractures. Strategies Trauma Limb Reconstr 2021;16(1):32-40.

Keywords: Circular external fixation; Clinical outcomes; Complex tibial fractures.