Long-term outcome after lower extremity injuries in severely injured patients

Background: Extremity injuries, often caused by road accidents, are an increasing problem worldwide. The aims of this study were (1) to describe the characteristics of lower extremity injuries (LEI) in polytrauma patients, (2) to describe long-term outcomes, and (3) to assess the relationship between the various domains of the International Classification of Functioning, Disability and Health (ICF model). Materials and Methods: A prospective cohort study was conducted from 1999 through 2000. All (n = 507) consecutive severely injured patients (ISSH≥16) over the age of 16 years were included. Results: One-hundred and eighty six (139 men, 47 women) had suffered LEI; mean age was 37 years, mean ISS 25. At follow-up, a mean permanent impairment of 14% was found according to the criteria of the American Medical Association. In terms of the Glasgow Outcome Scale, 28% of patients recovered incompletely. Half of the patients reported limitations in activities of daily living and mobility and 60% were unable to walk more than 3 km. The overall Sickness Impact Profile-136 score showed mild/moderate disability. Scores on six subscales of the Short Form-36 were significantly below the normative data. Regression analyses showed low beta and R-square values, indicating poor association between impairment and other outcome measurements. Conclusions: The impact of LEI on mobility, activities and participation level of polytrauma patients is considerable. Instruments measuring function do not agree well with those measuring activities or participation. Instruments measuring impairment do not agree well with long-term outcomes relating to activities and participation.