[The determinants of the quality of life after a type-III open tibial fracture. The results of a multicenter study]. / Determinanten der Lebensqualität nach offenem Unterschenkelbruch Typ III. Ergebnisse einer Multicenterstudie.

ABSTRACT

This study investigated to what extent quality of life four years or more after the fracture is determined by initial staging (Gustilo subclassification, time from injury to arrival at hospital), by the therapeutic course (length of hospital stay, number of operations), by complications (amputation, infection) and by demographic factors (gender, age). A total of 197 patients after type III open tibial shaft fractures (type IIIA 70, type IIIB 85, type IIIC 42) from nine centers volunteered to participate in this study. During patients' follow-up appointments (mean duration of follow-up 50 months), therapeutic course, pre-surgical staging and demographic data were recorded by the surgeon. Patients were asked to rate quality of life on the Nottingham Health Profile and on a visual analogue scale. Multiple regression analysis (stepwise) identified two predictors for reducing overall quality of life (F-test P = 0.007) number of operations (adjusted beta -0.21) and age (adjusted beta -0.17). Other factors showed no significant relationship with overall quality of life or with subscales of the Nottingham Health Profile. These findings indicate a dilemma between two therapeutic goals good functional outcome, which often requires repeated operations, and quality of life, which suffers under prolonged surgical treatment.