Medium-term recovery of patients with complex lower limb fractures : follow-up study of fracture types in the Wound Healing in Surgery for Trauma (WHIST) trial

Complex fractures of the lower limb are serious injuries, but little is known about longer-term recovery. The aim of this study was to report disability, pain, and health-related quality of life (HRQoL) of patients with different fracture types up to five years after operative treatment for complex lower limb fractures. This study involved secondary analysis of fracture types in the follow-up study of the Wound Healing in Surgery for Trauma (WHIST) trial population. Adults aged ≥ 16 years with complex fractures of the lower limb who received operative treatment at 24 hospitals in the UK were followed up for five years after surgery. The primary outcome was the Disability Rating Index (DRI). Secondary outcomes were HRQoL (EuroQol five-dimension five-level (EQ-5D-5L) questionnaire), and the incidence of neuropathic pain using the Doleur Neuropathique Questionnaire (DN4). The study cohort comprised 868 patients who completed at least one set of outcome data of the long-term follow-up study and had fracture type data available. The fracture distribution of the study cohort was acetabulum n = 67 (7.8%), hip n = 249 (28.7%), femur diaphysis n = 119 (13.7%), distal femur n = 72 (8.3%), tibia diaphysis n = 82 (9.4%), proximal tibia n = 193 (22.2%), distal tibia n = 40 (4.6%), and tibia plafond n = 46 (5.3%). There were marked improvements in DRI and EQ-5D-5L across all fractures at one year, but little improvement thereafter. Almost all patients who reported neuropathic pain at one year continued to experience persistent pain at five years. In this secondary analysis of the five-year follow-up study, we observed a similar pattern of recovery across all lower limb fractures. The high levels of disability and lower QoL experienced by patients in the year after their injury are persistent, and patients are unlikely to return to their preinjury health state in the medium term.