Patient Reported Outcomes After Definitive Open Tibial Fracture Management

Ryan Higgin, Jon Palmer, Amir Qureshi, Nicholas Hancock

University Hospital Southampton

Open tibial fractures are often life-changing injuries and outcomes remain poor despite national management guidelines. The longer-term impact to the patient can be considerable but is frequently overlooked in the literature. This study aims to establish the functional, physical, and psychosocial impact of sustaining an open tibial fracture.

We reviewed 69 consecutive Gustilo-Anderson grade IIIB and IIIC open tibial fractures presenting to our MTC between September 2012 and April 2018. Participants were interviewed and sent patient-reported outcome questionnaires a minimum of 12 months following injury. Our primary outcome was the Lower Extremity Functional Scale (LEFS). Secondary outcomes included the Short-Form 36 Healthy Survey (SF-36), Sickness Impact Profile 128 (SIP) and return to occupation. Subgroups were analysed according to age, Injury Severity Score (ISS) and limb amputation.

Our study response rate was 72% with mean follow up 43 months. The mean LEFS was 42 (IQR 21.5 – 58.5). All total and sub-domain scores within the SF-36 and SIP questionnaires were reduced compared to normative population data. 48% of patients returned to full time employment. Subgroup analysis revealed significantly reduced LEFS, SIP and SF-36 subdomain scores for those with a presenting ISS>14 and those undergoing limb amputation.

Patients have significant risk of longer-term functional, physical and psychosocial harm after suffering an open tibial fracture. Those sustaining major polytrauma or amputation demonstrated greatest risk of poor outcome. Early identification of these individuals likely to suffer most from their injury would help direct appropriate resources to those with greatest need at the earliest opportunity.