Residual Disability After Distal Tibial Fractures

It's nice to know how to tell patients with bad fractures what to expect in terms of recovery, and this study answers that question out to 5 years for patients with distal tibial fractures.

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Smart Practice: When counseling patients with fractures, we need to know when patients are likely to reach maximal recovery; among patients treated for extra-articular distal tibial fractures, that time is about one year after surgery.

What’s the Claim?

A 5-year follow-up of an earlier, major randomized trial published in JAMA found no differences between a locking plate and an intramedullary nail for extra-articular distal tibial fractures in terms of residual disability, quality of life, or complications. The study enrolled patients whose fractures were within two “Müller squares” of the ankle. (I had to look up Müller square — Müller defined a square based upon the width of the patient’s distal tibia in order to have a measurement that normalizes height and skeletal size across patients of different sizes.) The study also found that for most patients, levels of disability leveled off about 12 months after surgery, and that according to the Disability Rating Index, the level of persistent disability — which stayed about the same from one year to five years of follow-up — was about 20%.

How’s It Stack Up?