Long-Term Outcomes after Lower Extremity Trauma

Abstract

Previous studies have shown that over one-quarter of patients who were working before a severe lower extremity fracture had not returned to work by 12 months after injury. Disabilities also persisted in household management, recreation, and social interaction. The objective of this study was to determine whether recovery extended beyond 12 months. Three hundred nineteen patients who were previously working and were treated at three level I trauma centers for a severe lower extremity fracture were prospectively followed at 3, 6, and 12 months after injury. Patients were queried at each follow-up about their work status and completed the Sickness Impact Profile (SIP) at 6 and 12 months. The SIP is a widely used and well validated measure of general health status; it was used in this study to measure functional recovery across several domains of daily living. Patients who had not recovered by 12 months (i.e., 204 who were not working, working with limitations, or had limitations in performing other daily activities as measured by elevated scores on the SIP) were contacted again at 30 months and asked to complete an interview and the SIP. At 30 months, an estimated 82% of the study patients had returned to work (compared to 72% at 12 months). SIP scores improved only slightly from 6.4 at 12 months to 5.7 at 30 months. At 30 months, 64% of the patients had no disability (SIP scores less than 4), 17% had mild disability (SIP scores of 4 to 9), 12% had moderate disability (SIP scores of 10 to 19), and 7% had severe disability (SIP scores of 20 or higher). Although the majority of patients with persistent disabilities at 30 months had residual physical impairments at 12 months, the extent of impairment did not fully explain why some people had and had not recovered at 30 months after injury. The results confirm those of other studies that conclude that overall, outcomes after serious trauma are good when appropriate trauma and rehabilitation care are rendered. However, a minority of patients still report limitations at 30 months after injury, with one-fifth not returning to work.

The practice of plastic surgery in emergency trauma surgery: a retrospective glance at 10,732 patients

“…However, complicated injuries, unless treated appropriately, may cause serious loss of function, and this may lead to considerable disability and reduced life quality. [6,7] In the structure of various centers, there are two different rooms, namely an intervention room for plastic surgery and an operation theater. In the event there is no life-threatening situation and repair under local anesthesia is possible, many patients can be treated in the intervention room.…”

“…However, injuries related to plastic surgery may result in considerable disability and loss of life quality. [6,7] Our review of the literature revealed a few studies in which the issues within the field of interest of emergency plastic surgery, such as upper extremity surgery, head-and-neck traumas, and soft tissue traumas, were examined individually; however, no publication involved every field of practice of emergency plastic surgery. Therefore, retrospectively reviewing 10,732 patients admitted to the Emergency Plastic Surgery Department in Şişli Etfal Training and Research Hospital between 2000 and 2004, we aimed to construct a reference study stressing the significance of emergency plastic and reconstructive surgery in trauma centers.…”

Development and preliminary validation of a Function IndeX for Trauma (FIX-IT)

“…When asked if there were any additional items to consider including in the FIX-IT measure, 2 reviewers suggested including return to work, a patient-important outcome that indicates the ability to resume both physical and mental activities. 17 As a substantial proportion of patients will not return to work even 2 years after the fracture occurrs, 18 return to work as a measure of fracture healing may not be very responsive to change. 17 Therefore, the developers opted not to incorporate questions on return to work.…”

Critical Issues in Translational and Clinical Research for the Study of New Technologies to Enhance Bone Repair

“…Although adequate surgical treatment might restore full function and quality of life, there remains a finite risk of permanent deficit as well as the risk of a complication during the course of healing 1,2 . The risk of permanent deficits or complications depends on fracture characteristics, patient-related risk factors, and treatment-specific complications [3][4][5][6][7] .…”