PAPER 024: FUNCTIONAL, GENERAL, AND DISABILITY OUTCOMES AFTER TIBIAL NAILING: A RANDOMIZED CONTROLLED TRIAL

Abstract

Purpose: Tibial shaft fractures are a common injury. Tibial nailing is the current standard of care for these injuries, yet there is little information regarding patient based outcomes after nailing. We sought to determine the 1 year patient based outcomes and return to activities for patients with tibia fractures in a randomized trial of reamed and unreamed nail insertion.

Method: Over a 5 year period 1226 patients with 842 closed and 406 open tibial shaft fractures were enrolled in a randomized trial comparing reamed with unreamed tibial nail insertion in 29 trauma centers and had one year follow-up. The average age was 39±16 years and 74% were male. Patient based outcomes were determined using the validated Short Form-36 (SF-36) Physical Component Summary, the Short Musculoskeletal Functional Assessment (SMFA) Dysfunction Index, and a published return to activity questionnaire. Questionnaires were administered during the initial hospitalization to obtain pre-injury status, and then the same outcome instruments were used at the 2 week, 3 month, 6 month, and one year follow-up. Statistical analysis was performed comparing the groups with p < 0.05 designated as significant.

Results: There was no difference in any outcome parameter for any time frame between the reamed and unreamed groups. The 1 year SF-36 PCS (a 100 point scale with a mean of 50 in the general population, higher better) was 42.9±11 for the reamed group and 43.5±11 for unreamed group as compared with 52.5±9 for the reamed group and 53.1±9 for the unreamed group pre-injury. The SMFA Dysfunction Index (100 point scale, higher is worse) at 1 year was 18.2±17 for the reamed group and 17.5±17 for the unreamed group as compared with 7.9±13 for the reamed group and 7.7±13 unreamed group pre-injury.

Conclusion: In patients with tibial shaft fractures treated with intramedullary nails, patient based outcomes are not related to reamed or unreamed insertion. Patients sustaining tibial shaft injuries do not return to their pre-injury status based on validated outcomes assessments or return to activity by one year after injury.