THE SURGICAL MANAGEMENT OF COMPLEX TIBIAL AND FEMORAL NON-UNION – IS RETURN TO WORK PREDICTABLE?

Abstract

Introduction: We studied the radiological and functional outcome in patients treated for complex femoral and tibial non unions with the Ilizarov method, specifically analysing the data for factors that may predict return to work.

Methods and Results: 78 patients were treated for femoral and tibial non-union at our institute between January 1992 and December 2003. Of these 40 patients (41 non-union) satisfied the criteria for complex non-union. 18 patients who were working at the time of injury failed to return to work and 7 had returned to work. 16 were not employed at the time of injury and were excluded from the analysis. Functional and radiological outcome was assessed using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria. The minimum follow up was 18 months after removal of the frame.

Qualitative data for age, time to Ilizarov treatment, number of surgical procedures and time to union did not differ between the two groups (Student t-test). Those returning to work were more likely to have had a hypertrophic non union (p< .025) and were less likely to be using a walking aid (p< .05). No difference was seen between the groups with regards to segment involved, smoking, NSAID use, associated injuries, previous fixation, length of bone defect, free flap coverage, presence of infection, radiological and functional score.

Discussion: Our results suggest that return to work following Ilizarov treatment of a complex non-union does not correlate with either the biology of the fracture, the time course of treatment or the final result. We hypothesise that it is likely to be related to personality traits of the patients.