Little, Z;
Smith, TO;
McMahon, SE;
Cooper, C;
Trompeter, A;
Pearse, M;
Britten, S;
Rogers, B;
Sharma, H;
Narayan, B;
et al.
Little, Z; Smith, TO; McMahon, SE; Cooper, C; Trompeter, A; Pearse, M; Britten, S; Rogers, B; Sharma, H; Narayan, B; Costa, M; Beard, DJ; Hing, CB
(2017)
The treatment of segmental tibial fractures: does patient preference differ from surgeon choice?
Injury, 48 (10).
pp. 2306-2310.
ISSN 1879-0267
https://doi.org/10.1016/j.injury.2017.08.014
SGUL Authors: Hing, Caroline Blanca Trompeter, Alex Joel
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Abstract
INTRODUCTION: Segmental tibial fractures are complex injuries with a prolonged recovery time. Current definitive treatment options include intramedullary fixation or a circular external fixator. However, there is uncertainty as to which surgical option is preferable and there are no sufficiently rigorous multi-centre trials that have answered this question. The objective of this study was to determine whether patient and surgeon opinion was permissive for a randomised controlled trial (RCT) comparing intramedullary nailing to the application of a circular external fixator. MATERIALS AND METHODS: A convenience questionnaire survey of attending surgeons was conducted during the United Kingdom's Orthopaedic Trauma Society annual meeting 2017 to determine the treatment modalities used for a segmental tibial fracture (n=63). Patient opinion was obtained from clinical patients who had been treated for a segmental tibial fracture as part of a patient and public involvement focus group with questions covering the domains of surgical preference, treatment expectations, outcome, the consent process and follow-up regime (n=5). RESULTS: Based on the surgeon survey, 39% routinely use circular frame fixation following segmental tibial fracture compared to 61% who use nail fixation. Nail fixation was reported as the treatment of choice for a closed injury in a healthy patient in 81% of surgeons, and by 86% for a patient with a closed fracture who was obese. Twenty-one percent reported that they would use a nail for an open segmental tibia fracture in diabetics who smoked, whilst 57% would opt for a nail for a closed injury with compartment syndrome, and only 27% would use a nail for an open segmental injury in a young fit sports person. The patient and public preference exercise identified that sleep, early functional outcomes and psychosocial measures of outcomes are important. CONCLUSION: We concluded that a RCT comparing definitive fixation with an intramedullary nail and a circular external fixator is justified as there remains uncertainty on the optimal surgical management for segmental tibial fractures. Furthermore, psychosocial factors and early post-operative outcomes should be reported as core outcome measures as part of such a trial.
Item Type: | Article | |||||||||
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Additional Information: | © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ | |||||||||
Keywords: | Fracture, Preference, Segmental, Surgeon, Tibia, Trial, Fracture, Preference, Segmental, Surgeon, Tibia, Trial, Orthopedics, 1103 Clinical Sciences, 1110 Nursing, 1117 Public Health And Health Services | |||||||||
SGUL Research Institute / Research Centre: | Academic Structure > Institute of Medical & Biomedical Education (IMBE) Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Vascular & Cardiac Surgery (INCCVC) |
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Journal or Publication Title: | Injury | |||||||||
ISSN: | 1879-0267 | |||||||||
Language: | eng | |||||||||
Dates: |
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Publisher License: | Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0 | |||||||||
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PubMed ID: | 28818324 | |||||||||
Go to PubMed abstract | ||||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/109119 | |||||||||
Publisher's version: | https://doi.org/10.1016/j.injury.2017.08.014 |
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