Long-term outcomes after high-energy open tibial fractures: Is a salvaged limb superior to prosthesis in terms of physical function and quality of life?

The aim of this study was to describe complication rates and long-term functional outcomes among patients with amputated versus reconstructed limb after high-energy open tibial fractures.

Patients treated operatively for a high-energy open tibial fracture, classified as Gustilo–Anderson (GA) grade 3, at our hospital in the time period 2004–2013 were invited to a clinical and radiographic follow-up at minimum 2 years after injury. Eighty-two patients with 87 GA grade 3 fractures were included. There were 39 type GA 3A, 34 GA 3B, and 14 GA 3C.

The GA 3A reconstruction group had the lowest complication rate and the best long-term outcome scores at mean 5 years (range 2–8 years) after injury. Within the group of GA 3B and 3C fractures, we found no significant differences in long-term outcomes among patients with reconstructed versus amputated limbs. The mean physical component summary score of the SF-36 in the reconstruction versus amputation group was 54.2 (95% CI 46.3–62.1) versus 47.7 (95% CI 32.6–62.2), respectively (p = 0.524), while the mean mental component summary score was 63.7 (95% CI 50.6–71.8) versus 59.2 (95% CI 48.8–68.0), respectively (p = 0.603). On the 6-minute walk test, the reconstruction group walked on average 493 m (95% CI 447–535 m) versus 449 m (95% CI 384–518 m) in the amputation group. The return to work rate was 73% (16 of 22) in the reconstruction group versus 50% (7 of 14) in the amputation group (p = 0.166). The mean patient satisfaction score (VAS 0–100) was 67 (95% CI 67–77) in the reconstruction group versus 65 (95% CI 51–76) in the amputation group (p = 0.795). Regardless of the treatment strategy, the complication rate was high.

Amputation should be considered as a viable treatment option, equal to limb salvage, after high-energy open tibial fracture with severe vascular damage or soft tissue loss.