Late outcome of isolated tibial fractures treated by intramedullary nailing: the correlation between disease-specific and generic outcome measures.

Abstract

To measure the late morbidity of nailed isolated tibial fractures, using both a generic health score and disease-specific scores. To determine the correlation between the two types of outcome measure. Retrospective study, using a combination of case notes and radiographic review plus current clinical assessment. Fracture Outcomes Research Unit in a U.K. teaching hospital. Eighty-three patients with isolated fractures of the tibial diaphysis. Follow-up time was a minimum of three years from injury (mean fifty-seven months). All patients were treated primarily by closed, reamed intramedullary nailing. Iowa Knee and Ankle Scores, visual analogue pain scores for fracture site and knee and ankle joints, and the Short Form 36 health status questionnaire. Sixty-four (77.1%) fractures united after the first procedure. Twenty-nine (34.9%) patients had pain around the knee at rest, fifty-nine (71.1%) had difficulty in kneeling, and thirteen (15.7%) were still experiencing some pain at their fracture site; 69% of patients had excellent results based on the Iowa scores as well as the SF-36 scores. Pain at the knee correlated with low Physical Component Summary and Mental Component Summary scores, and fracture site pain correlated with only low Physical Component Summary score. There was a significant correlation between the disease-specific scores and the SF-36 scores, and only patients with an excellent Iowa grade had "normal" SF-36 scores. After tibial nailing, mild deficits registered by Iowa scores are associated with a significant disability and unhappiness as registered by the SF-36. According to the patient-oriented outcomes tool, 31% of late results are "unsatisfactory."