[Reconstruction or amputation in complex fractures of the tibia. A comparative study with special reference to insurance medicine aspects].

As an introduction to the subject, a historical retrospective review of the pension-related outcome of fractures of the tibia and fibula is presented. Analysis of the past 50 years shows a continuous reduction in the frequency of the award of pensions in such cases, from 36% to 2.2%. A retrospective Swiss study is then presented, in which 18 patients with below-the-knee amputations are compared with 21 patients with limb-salvage of the lower leg. Medical insurance parameters such as length of hospitalisation, number of operations, duration of rehabilitation and the level of rehabilitation achieved, with the degree of functioning of the leg and any occupational changes are considered, and finally the frequency of the award of pensions and the costs involved are determined and compared. According to these results, better overall functioning of the leg can today be achieved in the cases with successful limb-salvage; when costs are compared, taking into account the pension costs, in this Swiss study limb-salvage is the most economical solution. These results are in contrast to an American study which shows a medically and economically more favourable outcome in the case of amputations. In order to obtain better results with the costly limb-salvage procedures, improvements and advances in diagnosis, surgical techniques and rehabilitation are required. These requirements from the American study can be endorsed although, the Swiss study presents more favourable results. Both studies cover very heterogeneous patient populations and may be compared only conditionally.