Medium-term Self Reported Functional Outcomes of Tibial Nailing and Their Associations at the Kenyatta National Hospital

Abstract

Background: A significant number of patients sustain tibial fractures with a global annual incidence of 16.9 per 100000 representing 2% of all fractures. Tibial nailing is a commonly used method of treatment. No studies have investigated the outcomes of treatment of tibial diaphyseal fractures with tibial nails in a local setting. Inadequate knowledge of these outcomes has hindered interrogation of the current management protocols. Objective: To determine the self-reported functional outcomes of treatment of tibial fractures with tibial locking nail at the KNH. Method: This was a cross-sectional study carried out at KNH orthopedic department. A total of 46 patients over the age of 18 years who had tibial fractures of all patterns regardless of whether they were open or closed and underwent tibial nailing at the KNH were recruited. The lower extremity functional scale (LEFS) score was used to measure self-reported functional outcomes of treatment at six months. Statistical analysis: Data on the patient’s LEFS scores, demographic, and clinical characteristics was cleaned and entered the SPSS tool, mainly version 24.0 for data purposes. The prevalence of the described medium-term outcomes post-tibia nailing was derived as a proportion of patients with an event divided by the total sample size. To evaluate the existing correlations of the identified outcomes, the Chi-square test as a data analysis tool of independence was used for variances in percentages. The Student T-test was utilized to evaluate the variations in the means from the study. The statistical significance was set at <0.05. Results: The mean age (MA) of patients with diaphyseal tibial fractures treated with the tibial locking nail was 30.8(SD±8.9) years and 76.1% of the patients were male. Road traffic accidents (RTA) (82,6%) and falls were the leading mechanisms of injury. Only 8.7% of the patients had comorbidities. 45% of the patients had open fracture, 78% had an associated fibula fracture. Majority (63%) had AO type 32C fracture. The mean LEFS score was 56.1(SD±14.5) with scores ranging between 21 and 78. Further, 41.3% had fair functional status, 28.3% had good functional status, 17.4% had excellent functional status and 13% had poor functional status. Those patients diagnosed with comorbidities reported a considerably inferior functional rank of 44.5(SD±22.1) than participants who did not have comorbidities at 57.2(SD±13.4), p =0.009. Conclusion and recommendation: Most patients with diaphyseal fractures treated with tibial locking had good to fair functional outcomes at six months post-surgical procedure. These results are comparable to findings from other studies. There was an expectation that the outcomes would improve with time. The presence of comorbidities and the severity of the fracture patterns correlated poorly with functional outcomes. However, the sample sizes in some sample categories were not statistically significant. Thus, there is a need for additional longitudinal studies to elucidate factors affecting functional outcomes as well as well as long-term functional recovery