Long-term persistence of disability following severe lower-limb trauma

Results of a seven-year follow-up

Ellen J Mackenzie, Michael J. Bosse, Andrew N. Pollak, Lawrence X. Webb, Marc F. Swiontkowski, James F. Kellam, Douglas G. Smith, Roy W. Sanders, Alan L. Jones, Adam J. Starr, Mark P. McAndrew, Brendan M. Patterson, Andrew R. Burgess, Renan Carlos Castillo

Research output: Contribution to journalArticle

Abstract

Background: A recent study demonstrated that patients treated with amputation and those treated with reconstruction had comparable functional outcomes at two years following limb-threatening trauma. The present study was designed to determine whether those outcomes improved after two years, and whether differences according to the type of treatment emerged. Methods: Three hundred and ninety-seven patients who had undergone amputation or reconstruction of the lower extremity were interviewed by telephone at an average of eighty-four months after the injury. Functional outcomes were assessed with use of the physical and psychosocial subscores of the Sickness Impact Profile (SIP) and were compared with similar scores obtained at twenty-four months. Results: On the average, physical and psychosocial functioning deteriorated between twenty-four and eighty-four months after the injury. At eighty-four months, one-half of the patients had a physical SIP subscore of ≥10 points, which is indicative of substantial disability, and only 34.5% had a score typical of a general population of similar age and gender. There were few significant differences in the outcomes according to the type of treatment, with two exceptions. Compared with patients treated with reconstruction for a tibial shaft fracture, those with only a severe soft-tissue injury of the leg were 3.1 times more likely to have a physical SIP subscore of 5 points (p <0.05) and those treated with a through-the-knee amputation were 11.5 times more likely to have a physical subscore of 5 points (p <0.05). There were no significant differences in the psychosocial outcomes according to treatment group. Patient characteristics that were significantly associated with poorer outcomes included older age, female gender, nonwhite race, lower education level, living in a poor household, current or previous smoking, low self-efficacy, poor self-reported health status before the injury, and involvement with the legal system in an effort to obtain disability payments. Except for age, predictors of poor outcome were similar at twenty-four and eighty-four months after the injury. Conclusions: The results confirm previous conclusions that reconstruction for the treatment of injuries below the distal part of the femur typically results in functional outcomes equivalent to those of amputation. Regardless of the treatment option, however, long-term functional outcomes are poor. Priority should be given to efforts to improve post-acute-care services that address secondary conditions that compromise optimal recovery. Level of Evidence: Prognostic Level II.

Original languageEnglish (US)
Pages (from-to)1801-1809
Number of pages9
JournalThe Journal of bone and joint surgery. American volume
Volume87
Issue number8
DOIs
StatePublished - Aug 2005

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Lower Extremity
Sickness Impact Profile
Amputation
Wounds and Injuries
Subacute Care
Therapeutics
Soft Tissue Injuries
Tibial Fractures
Self Efficacy
Telephone
Femur
Health Status
Leg
Knee
Extremities
Smoking
Education
Population

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Long-term persistence of disability following severe lower-limb trauma : Results of a seven-year follow-up. / Mackenzie, Ellen J; Bosse, Michael J.; Pollak, Andrew N.; Webb, Lawrence X.; Swiontkowski, Marc F.; Kellam, James F.; Smith, Douglas G.; Sanders, Roy W.; Jones, Alan L.; Starr, Adam J.; McAndrew, Mark P.; Patterson, Brendan M.; Burgess, Andrew R.; Castillo, Renan Carlos.

In: The Journal of bone and joint surgery. American volume, Vol. 87, No. 8, 08.2005, p. 1801-1809.

Research output: Contribution to journalArticle

Mackenzie, EJ, Bosse, MJ, Pollak, AN, Webb, LX, Swiontkowski, MF, Kellam, JF, Smith, DG, Sanders, RW, Jones, AL, Starr, AJ, McAndrew, MP, Patterson, BM, Burgess, AR & Castillo, RC 2005, 'Long-term persistence of disability following severe lower-limb trauma: Results of a seven-year follow-up', The Journal of bone and joint surgery. American volume, vol. 87, no. 8, pp. 1801-1809. https://doi.org/10.2106/JBJS.E.00032
Mackenzie, Ellen J ; Bosse, Michael J. ; Pollak, Andrew N. ; Webb, Lawrence X. ; Swiontkowski, Marc F. ; Kellam, James F. ; Smith, Douglas G. ; Sanders, Roy W. ; Jones, Alan L. ; Starr, Adam J. ; McAndrew, Mark P. ; Patterson, Brendan M. ; Burgess, Andrew R. ; Castillo, Renan Carlos. / Long-term persistence of disability following severe lower-limb trauma : Results of a seven-year follow-up. In: The Journal of bone and joint surgery. American volume. 2005 ; Vol. 87, No. 8. pp. 1801-1809.
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AU - Pollak, Andrew N.

AU - Webb, Lawrence X.

AU - Swiontkowski, Marc F.

AU - Kellam, James F.

AU - Smith, Douglas G.

AU - Sanders, Roy W.

AU - Jones, Alan L.

AU - Starr, Adam J.

AU - McAndrew, Mark P.

AU - Patterson, Brendan M.

AU - Burgess, Andrew R.

AU - Castillo, Renan Carlos

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N2 - Background: A recent study demonstrated that patients treated with amputation and those treated with reconstruction had comparable functional outcomes at two years following limb-threatening trauma. The present study was designed to determine whether those outcomes improved after two years, and whether differences according to the type of treatment emerged. Methods: Three hundred and ninety-seven patients who had undergone amputation or reconstruction of the lower extremity were interviewed by telephone at an average of eighty-four months after the injury. Functional outcomes were assessed with use of the physical and psychosocial subscores of the Sickness Impact Profile (SIP) and were compared with similar scores obtained at twenty-four months. Results: On the average, physical and psychosocial functioning deteriorated between twenty-four and eighty-four months after the injury. At eighty-four months, one-half of the patients had a physical SIP subscore of ≥10 points, which is indicative of substantial disability, and only 34.5% had a score typical of a general population of similar age and gender. There were few significant differences in the outcomes according to the type of treatment, with two exceptions. Compared with patients treated with reconstruction for a tibial shaft fracture, those with only a severe soft-tissue injury of the leg were 3.1 times more likely to have a physical SIP subscore of 5 points (p <0.05) and those treated with a through-the-knee amputation were 11.5 times more likely to have a physical subscore of 5 points (p <0.05). There were no significant differences in the psychosocial outcomes according to treatment group. Patient characteristics that were significantly associated with poorer outcomes included older age, female gender, nonwhite race, lower education level, living in a poor household, current or previous smoking, low self-efficacy, poor self-reported health status before the injury, and involvement with the legal system in an effort to obtain disability payments. Except for age, predictors of poor outcome were similar at twenty-four and eighty-four months after the injury. Conclusions: The results confirm previous conclusions that reconstruction for the treatment of injuries below the distal part of the femur typically results in functional outcomes equivalent to those of amputation. Regardless of the treatment option, however, long-term functional outcomes are poor. Priority should be given to efforts to improve post-acute-care services that address secondary conditions that compromise optimal recovery. Level of Evidence: Prognostic Level II.

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