Abstract
Introduction
Advances in the management of open tibial fractures have reduced the incidence of long-term complications of these injuries. However, a number of patients continue to suffer from sequelae such as infection, non-union and malunion. Many orthopaedic surgeons believe a below-knee amputation with a well-fitted prosthesis is a better alternative to limb reconstruction surgery. There are few studies that evaluate the long-term functional outcomes of amputees against patients who have undergone limb salvage procedures, and their results are conflicting. The hypothesis of this study is that patients who have undergone limb salvage have as good or better outcomes than those who have had below-knee amputations.
Methods
This is a retrospective case study. One group (n=12) had been treated with below-knee amputation following a variety of lower limb fractures. The other group (n=11) had developed complications following tibial fractures and undergone limb salvage surgery using the Ilizarov method. The groups were compared by means of a postal questionnaire, comprising the Oswestry Disability Index and the SF-36 Health Survey.
Results
There were no statistically significant differences between the groups for any of the health scales measured. However, for the two scales in the SF-36 measuring functional health (Physical Functioning and Role-Physical) the differences were much lower than for any of the other scales (both p=0.13). The 95% confidence intervals for the difference between the means for each group were -6.4 to 45.4 for PF and -7.4 to 61.2 for RP.
Discussion
This study provides evidence that limb conserving surgery offers a genuine improvement in long term functional health. The failure to reach statistical significance is a reflection of the relatively small numbers of patients affected and the difficulties in collecting data retrospectively.
