Orthopedics and Traumatology Surgery resident) school of Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Assistant professor of Orthopedics and Traumatology Surgery, rehabilitation specialist, school of Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
BMC Surg. 2023 Aug 23;23(1):250. doi: 10.1186/s12893-023-02155-8.
Tibial shaft fractures are the most common long bone fractures requiring treatment. High-energy trauma often causes tibia bone injuries, causing severe complications and long-term disability due to inadequate soft tissue coverage. Tibial shaft fractures can be treated using casts, external fixators, plating, or intramedullary nails. Intramural nailing leads to faster union and reduced complications like malunion and shortening. However, patients often report subjective and objective difficulties after Surgical Instrument generation network (SIGN) nail fixation, affecting knee range of motion, quality of life, and sport activities. Tibial nails and plates are associated with increased knee pain, which negatively affects functional outcomes. No study has been conducted in a poor resource setting like Ethiopia. This study aims to assess functional outcomes of the knee and associated factors after intramedullary nailing of Tibial Diaphysial Fractures at AaBET hospital in Ethiopia.
A retrospective health facility based cross-sectional study was conducted on functional outcomes of the knee and associated factors after intramedullary nailing of tibial diaphysial fractures done at AaBET hospital. A medical record review form and a structured questionnaire from patient chart and SIGN nail database collected data. The study was conducted on 151 patients registered on the SIGN nail database using a simple random sampling. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to assess the knee functional outcome. Descriptive statistics such as frequency and percentage were used to summarize the results and binary logistic regression was used to describe the association between variables. P value < 0.05 was considered statistically significant association.
The study constituted 151 patients with tibial shaft fractures; 113(74.8%) males and 38(25.2%) females with a mean age of 31.4 years, with a standard deviation of [10.5]. The prevalence of patients with good knee functional outcomes was 87(57.6%), while 64(42.4%) patients had poor knee functional outcomes. Associated factors identified include sex, age, soft tissue status, postoperative infection postoperative physiotherapy and comminuted fracture pattern.
This study determined the magnitude of knee functional outcomes revealed that more than half (57.6% ) of patients had good knee functional outcomes with identified factors increseaes odds of poor knee functional outcomes were sex, age, soft tissue injuries, post operative infection, postoperative physiotherapy and comminuted fracture patterns respectively. Therefore, Policymakers and health planners should closely monitor postoperative physiotherapy treatment courses among tibial shaft fractures treated with intramedullary nailing to increases good knee functional outcomes.
胫骨骨干骨折是最常见的需要治疗的长骨骨折。高能创伤常导致胫骨骨损伤，由于软组织覆盖不足，导致严重并发症和长期残疾。胫骨骨干骨折可采用石膏、外固定器、钢板或髓内钉治疗。髓内钉固定可导致更快的愈合，并减少畸形愈合和缩短等并发症。然而，患者在使用 Surgical Instrument generation network（SIGN）钉固定后常报告主观和客观困难，影响膝关节活动范围、生活质量和运动活动。胫骨钉和钢板会导致膝关节疼痛增加，从而对功能结果产生负面影响。在埃塞俄比亚等资源匮乏的环境中，尚未进行过此类研究。本研究旨在评估埃塞俄比亚 AaBET 医院使用髓内钉治疗胫骨骨干骨折后的膝关节功能结果及其相关因素。
采用回顾性基于医疗保健机构的病例对照研究，对 AaBET 医院使用髓内钉治疗胫骨骨干骨折后的膝关节功能结果及其相关因素进行研究。使用从患者病历和 SIGN 钉数据库中提取数据的病历审查表和结构化问卷。该研究对 SIGN 钉数据库中登记的 151 名患者进行了简单随机抽样。使用膝关节损伤和骨关节炎结果评分（KOOS）评估膝关节功能结果。使用频率和百分比等描述性统计方法总结结果，并使用二项逻辑回归描述变量之间的关联。P 值<0.05 被认为具有统计学意义。
该研究共纳入 151 例胫骨骨干骨折患者；男性 113 例（74.8%），女性 38 例（25.2%），平均年龄 31.4 岁，标准差为[10.5]。膝关节功能良好的患者患病率为 87 例（57.6%），而膝关节功能不良的患者为 64 例（42.4%）。确定的相关因素包括性别、年龄、软组织状况、术后感染、术后物理治疗和粉碎性骨折类型。
本研究确定了膝关节功能结果的严重程度，结果表明，超过一半（57.6%）的患者膝关节功能良好，而性别、年龄、软组织损伤、术后感染、术后物理治疗和粉碎性骨折类型等因素增加了膝关节功能不良的几率。因此，决策者和卫生规划人员应密切监测胫骨骨干骨折患者接受髓内钉治疗后的术后物理治疗治疗过程，以提高膝关节功能的良好结果。
