Driesman Adam, Fisher Nina, Konda Sanjit R, Pean Christian A, Leucht Philipp, Egol Kenneth A
NYU Hospital for Joint Diseases, 301 East 17th Street, Suite 1402, New York, NY, 10003, USA.
Jamaica Hospital Medical Center, 8900 Van Wyck Expy, Queens, NY, 11418, USA.
Arch Orthop Trauma Surg. 2017 Oct;137(10):1335-1340. doi: 10.1007/s00402-017-2766-z. Epub 2017 Jul 26.
Whether racial differences are associated with function in the long term following surgical repair of lower extremity fractures has not been investigated. The purpose of this study is to compare how race affects function at 3, 6 and 12 months post-surgery following certain lower extremity fractures.
Four hundred and eighteen patients treated operatively for a lower extremity fracture (199 tibial plateau, 39 tibial shaft, and 180 rotational ankle fractures) were prospectively followed for 1 year. Race was stratified into four groups: Caucasian, African-American, Hispanic origin, and other. Long-term outcomes were evaluated using the short musculoskeletal function assessment (SMFA) and pain scores were assessed at 3, 6 months and 1 year.
There were 223 (53.3%) Caucasians, 72 (17.2%) African-Americans, 53 (12.4%) Hispanics, and 71 (17.0%) patients from other ethnic groups, included in our study population. Minority patients (African-American, Hispanics, etc.) were more likely to be involved in high velocity mechanisms of injury and tended to have a greater percentage of open fractures. Although there were no differences in the rate of wound complications or reoperations, long-term functional outcomes were worse in minority patients as assessed by pain scores at 6 months and functional outcome scores at 3, 6 and 12 months. Multivariate analysis revealed that only African-American and Hispanic race continued to be independent predictors of worse functional outcomes at 12 months.
Racial minorities and those on medicaid had poorer long-term function following fractures of the lower extremity. While minority patients were involved in more high velocity accidents, this was not an independent predictor of worse outcomes. These disparities may result from multifactorial socioeconomic factors, including socioeconomic status and education levels that were not controlled in our study.
Prognostic Level III.
下肢骨折手术修复后的长期功能是否存在种族差异尚未得到研究。本研究的目的是比较种族如何影响特定下肢骨折术后3个月、6个月和12个月时的功能。
对418例接受下肢骨折手术治疗的患者（199例胫骨平台骨折、39例胫骨干骨折和180例旋后外旋型踝关节骨折）进行了为期1年的前瞻性随访。种族被分为四组：白种人、非裔美国人、西班牙裔和其他种族。使用简短肌肉骨骼功能评估（SMFA）评估长期结局，并在3个月、6个月和1年时评估疼痛评分。
我们的研究人群包括223例（53.3%）白种人、72例（17.2%）非裔美国人、53例（12.4%）西班牙裔和71例（17.0%）其他种族的患者。少数族裔患者（非裔美国人、西班牙裔等）更有可能遭遇高速损伤机制，并且开放性骨折的比例往往更高。尽管伤口并发症或再次手术的发生率没有差异，但通过6个月时的疼痛评分以及3个月、6个月和12个月时的功能结局评分评估，少数族裔患者的长期功能结局更差。多变量分析显示，只有非裔美国人和西班牙裔种族在12个月时仍然是功能结局较差的独立预测因素。
少数族裔和医疗补助患者下肢骨折后的长期功能较差。虽然少数族裔患者遭遇更多高速事故，但这并不是结局较差的独立预测因素。这些差异可能源于多因素社会经济因素，包括我们研究中未控制的社会经济地位和教育水平。
预后III级。
