Strategies in Trauma and Limb Reconstruction

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VOLUME 13 , ISSUE 1 ( April, 2018 ) > List of Articles

Original Article

Complex tibial fractures are associated with lower social classes and predict early exit from employment and worse patient-reported QOL: a prospective observational study of 46 complex tibial fractures treated with a ring fixator

Rasmus Elsoe, Peter Larsen, Juozas Petruskevicius, Søren Kold

Keywords : Ilizarov, Ring fixator, Complex fracture tibial bone, Plateau fracture, Pilon fracture, Outcome

Citation Information : Elsoe R, Larsen P, Petruskevicius J, Kold S. Complex tibial fractures are associated with lower social classes and predict early exit from employment and worse patient-reported QOL: a prospective observational study of 46 complex tibial fractures treated with a ring fixator. 2018; 13 (1):25-33.

DOI: 10.1007/s11751-017-0301-y

License: CC BY-NC-SA 4.0

Published Online: 30-04-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


The long-term outcomes following complex fractures of the tibia are reported to carry a risk of knee pain, malalignment, articular injury and post-traumatic osteoarthritis. The main objective of this study was to account for the patient-reported quality of life (QOL) 12 months after ring fixator removal in patients with a complex tibial fracture. Secondary objectives included a review of the socio-economic characteristics of the patient group and the rate of return to work in the study period. A prospective follow-up study was conducted of 60 patients with complex fractures of the tibia treated with ring external fixation. Patient-reported outcomes, radiological outcomes and socio-economic status including employment status of the patients were obtained 12 months after frame removal. Forty-six patients completed the assessment 12 months after frame removal (77%). The mean age of the patient at the time of fracture was 54.6 years (range 31–86). There were 19 males and 27 females. At 12 months after frame removal, the mean EQ5D-5L index was 0.66 (CI 0.60–0.72). The mean EQ5D-5L VAS was 69 (CI 61–76). When this was compared to the established reference population from Denmark, the study population showed a significantly worse EQ5D-5L index. The majority of patients (87%) were in the lower social classes suggesting a higher degree of social deprivation in the study population. Twenty-seven per cent of patients who were employed prior to injury had returned to employment at approximately 19 months following fracture. The onset of post-traumatic osteoarthritis was present in the knee joint in 29% of patients following a proximal intra-articular fracture, whereas osteoarthritis was present at the ankle joint in 35% of patients following a distal intra-articular fracture 12 months after frame removal. This study indicates that at 12 months after frame removal there are poorer patient-reported QOL as when compared to reference populations. Furthermore, this study suggests that complex tibial fractures are associated with lower social classes and that only 27% of patients in this sample, who prior to injury were employed, had returned to employment at approximately 19 months after the injury.

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  1. Jansen H, Frey SP, Doht S et al (2013) Medium-term results after complex intra-articular fractures. J Orthop Sci 8(4):569-577
  2. Joveniaux P, Ohl X, Harisboure A et al (2010) Distal tibia fractures: management and complications of 101 cases. Int Orthop 34:583-588
  3. Ramos T, Ekholm C, Eriksson BI et al (2013) The Ilizarov external fixator—a useful alternative for the treatment of proximal tibial fractures. A prospective observational study of 30 consecutive patients. BMC Musculoskelet Disord 14:11
  4. Ramos T, Karlsson J, Eriksson BI, Nistor L (2013) Treatment of distal tibial fractures with the Ilizarov external fixator—a prospective observational study in 39 consecutive patients. BMC Musculoskelet Disord 14:30
  5. Krappinger D, Irenberger A, Zegg M, Huber B (2013) Treatment of large posttraumatic tibial bone defects using the Ilizarov method: a subjective outcome assessment. Arch Orthop Trauma Surg 133:789-795
  6. Ali AM (2013) Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation. Eur J Orthop Surg Traumatol 23:349-355
  7. Manidakis N, Dosani A, Dimitriou R et al (2010) Tibial plateau fractures: functional outcome and incidence of osteoarthritis in 125 cases. Int Orthop 34:565-570
  8. Sament R, Mayanger JC, Tripathy SK, Sen RK (2012) Closed reduction and percutaneous screw fixation for tibial plateau fractures. J Orthop Surg (Hong Kong) 20:37-41
  9. Subasi M, Kapukaya A, Arslan H et al (2007) Outcome of open comminuted tibial plateau fractures treated using an external fixator. J Orthop Sci 12:347-353
  10. Korkmaz A, Ciftdemir M, Ozcan M et al (2013) The analysis of the variables, affecting outcome in surgically treated tibia pilon fractured patients. Injury 44:1270-1274
  11. Ahearn N, Oppy A, Halliday R et al (2014) The outcome following fixation of bicondylar tibial plateau fractures. Bone Joint J 96-B:956-962
  12. Metcalfe D, Hickson CJ, McKee L, Griffin XL (2015) External versus internal fixation for bicondylar tibial plateau fractures: systematic review and meta-analysis. J Orthop Traumatol 16(4):275-285
  13. Dall'oca C, Maluta T, Lavini F et al (2012) Tibial plateau fractures: compared outcomes between ARIF and ORIF. Strateg Trauma Limb Reconstr 7:163-175
  14. Ali AM, Burton M, Hashmi M, Saleh M (2003) Outcome of complex fractures of the tibial plateau treated with a beamloading ring fixation system. J Bone Joint Surg Br 85:691-699
  15. Canadian Orthopaedic Trauma Society (2006) Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Results of a multicenter, prospective, randomized clinical trial. J Bone Joint Surg Am 88:2613-2623
  16. Eq-5d questionnary (2012)
  17. Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium—2007: Orthopaedic Trauma Association Classification, database and outcome committee. J Orthop Trauma 21(10 Suppl):S1-S133
  18. Wittrup-Jensen KU, Lauridsen J, Gudex C, Pedersen KM (2009) Generation of a Danish TTO value set for EQ-5D health states. Scand J Public Health 37:459-466
  19. Sorensen J, Davidsen M, Gudex C et al (2009) Danish EQ-5D population norms. Scand J Public Health 37:467-474
  20. KOOS questionnaire [KOOS web site]. Accessed 12 June 2011
  21. Paradowski PT, Bergman S, Sunden-Lundius A et al (2006) Knee complaints vary with age and gender in the adult population. Population-based reference data for the Knee injury and Osteoarthritis Outcome Score (KOOS). BMC Musculoskelet Disord 7:38
  22. Olerud C, Molander H (1984) A scoring scale for symptom evaluation after ankle fracture. Arch Orthop Trauma Surg 103:190-194
  23. Olsen LR, Jensen DV, Noerholm V et al (2003) The internal and external validity of the Major Depression Inventory in measuring severity of depressive states. Psychol Med 33:351-356
  24. Bech P, Rasmussen NA, Olsen LR et al (2001) The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord 66:159-164
  25. Moller L, Kristensen TS, Hollnagel H (1991) Social class and cardiovascular risk factors in Danish men. Scand J Soc Med 19:116-126
  26. Rasmussen PS (1973) Tibial condylar fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am 55:1331-1350
  27. Marsh JL, Buckwalter J, Gelberman R et al (2002) Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am 84-A:1259-1271
  28. Burwell HN, Charnley AD (1965) The treatment of displaced fractures at the ankle by rigid internal fixation and early joint movement. J Bone Joint Surg Br 47:634-660
  29. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494-502
  30. McFerran MA, Smith SW, Boulas HJ, Schwartz HS (1992) Complications encountered in the treatment of pilon fractures. J Orthop Trauma 6:195-200
  31. Papagelopoulos PJ, Partsinevelos AA, Themistocleous GS et al (2006) Complications after tibia plateau fracture surgery. Injury 37:475-484
  32. Olsen L, Ploug N, Andersen L, Juul JS (2012) Det Danske Klassesamfund (the Danish Class Society), 1st edn. Gyldendal, Copenhagen
  33. Court-Brown CM, Aitken SA, Duckworth AD et al (2013) The relationship between social deprivation and the incidence of adult fractures. J Bone Joint Surg Am 95:e321-e327
  34. Danmarks Statistik. 18 Oct 2015
  35. Jacob N, Amin A, Giotakis N et al (2015) Management of highenergy tibial pilon fractures. Strateg Trauma Limb Reconstr 10(3):137-147
  36. Rademakers MV, Kerkhoffs GM, Sierevelt IN et al (2007) Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma 21:5-10
  37. Abd-Almageed E, Marwan Y, Esmaeel A et al (2015) Hybrid external fixation for Arbeitsgemeinschaft fur Osteosynthesefragen (AO) 43-C tibial plafond fractures. J Foot Ankle Surg 54(6):1031-1036
  38. Houben PF, van der Linden ES, van den Wildenberg FA, Stapert JW (1997) Functional and radiological outcome after intra-articular tibial plateau fractures. Injury 28:459-462
  39. Honkonen SE (1995) Degenerative arthritis after tibial plateau fractures. J Orthop Trauma 9:273-277
  40. HK. Danish flexicurity model. Published 2017. Accessed March 2017
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