Features of functional activity indices and risk of osteoporotic fractures in patients with femoral and tibial fractures (results of 12-month observation)
Keywords:hip fracture, tibial fracture, functional activity, Lower Extremity Functional Scale, Fracture Risk Assessment Tool
Background. Nowadays, the lower limb fractures amount to from one third to half of all fractures, resulting in the increased incidence of morbidity and mortality. The incidence of complications after these fractures remains high, complete functional recovery is not observed in all patients. Appropriate assessment of functional activity of patients in the post-fracture period and the risk of subsequent fractures remain relevant. The purpose was to study the parameters of functional activity and the risk of osteoporotic fractures in patients of older age groups with lower limb fractures of different localization. Materials and methods. Seventy two subjects with proximal femoral fractures (PFF, n = 23) and tibial fractures (TF, n = 49) were examined. Longitudinal observation of patients was conducted for 12 months with the assessment of parameters before fracture (retrospectively), as well as 6 and 12 months after. Methods: questioning, general clinical, anthropometric and orthopedic examination. Questionnaire survey was conducted using the Lower Extremity Functional Scale (LEFS) and Fracture Risk Assessment Tool (FRAX), which patients filled in themselves under the control of a physician. Results. The parameters of LEFS are reliably related to the age, gender, height, body mass index, 10-year risk of major osteoporotic fractures and hip fractures in patients with TF. Data of LEFS in women with PFF before fracture are significantly worse than corresponding indices in patients with TF, and are also related to age. The parameters of LEFS in patients 6 months after PFF and TF are significantly lower compared to baseline, which indicates a deterioration of patient’s functional abilities. The LEFS indices in patients 12 months after PFF and TF significantly increase and do not differ from baseline parameters in persons with PFF, but not in patients with TF. The 10-year probability of risk for major osteoporotic fractures and hip fractures according to the FRAX does not significantly differ depending on fracture location, and is higher in women with TF than in men. Conclusions. All of the above should be taken into account when planning treatment, preventive and rehabilitation measures in elderly people with lower limbs fractures.
Korzh NA, Gerasimenko SI, Klimovitskii VG, et al. The prevalence of bone fractures and the results of their treatment in Ukraine (clinical and epidemiological study). Meditsinskie novosti. 2011;(7):37-44 (in Russian).
Shyshhuk VD, Terehov AM, Shherbak BI, Tomyn LV, Shyshhuk AV, Zalishhuk VM. Perelomy kistok nyzhn'oi' kincivky: klinika, diagnostyka, likuvannja, reabilitacija: navchal'nyj posibnyk [Lower limbs fractures: clinic, diagnosis, treatment, rehabilitation: a textbook]. Sumy: Fabryka druku; 2015. 152 p. (in Ukrainian).
Holloway KL, Moloney DM, Brennan SL, et al. Foot and ankle fracture incidence in South-Eastern Australia: an epidemiological study. Clin Res Foot Ankle. 2014;(2):148-152. doi: 10.4172/2329-910X.1000148.
Holloway KL, Yousif D, Bucki-Smith G, et al. Lower limb fracture presentations at a regional hospital. Arch Osteoporos. 2017 Aug 28;12(1):75. doi: 10.1007/s11657-017-0369-5.
Bur'janov OA, Golka GG, Klymovyc'kyj VG, et al, authors; Golka GG, Bur'janov OA, Klymovyc'kyj VG, editors. Travmatologіja ta ortopedіja: pіdruchnik [Traumatology and orthopedics: a textbook]. Vіnnitsa: Nova knyga; 2014. 416 p. (in Ukrainian).
Clift B, Tibrewal SB. Fractures of the lower limb (includes foot). Available from: https://www.researchgate.net/publication/254506497_Fractures_of_the_Lower_Limb_includes_foot. Accessed: May 30, 2015.
Kalashnikov AV, Vdovichenko KV, Chalaydyuk TP. The efficacy of treatment of patients with dyaphysis fractures of lower extremities accomplished by modern osteosynthesis technology. Ukrai'ns'kyj morfologichnyj al'manah. 2010;8(1):39-42. (in Ukrainian).
Grygorieva NV, Vlasenko RO. Epidemiology and risk factors of lower limb fractures (literature review). Bolʹ, sustavy, pozvonočnik. 2017;7(3):127-38. doi: 10.22141/2224-1507.7.3.2017.116868. (in Ukrainian).
Rehman ZU, Sophie Z, Mal L. Functional outcomes after successful lower extremity arterial injuries repair. J Pak Med Assoc. 2016 Oct;66(Suppl 3)(10):S134-S136. PMID: 27895379.
Stavem K, Naumann MG, Sigurdsen U, Utvåg SE. The association of body mass index with complications and functional outcomes after surgery for closed ankle fractures. Bone Joint J. 2017 Oct;99-B(10):1389-1398. doi: 10.1302/0301-620X.99B10.BJJ-2016-1038.R1.
Chung KC, Kotsis SV, Kim HM. Predictors of functional outcomes after surgical treatment of distal radius fractures. J Hand Surg Am. 2007 Jan;32(1):76-83. doi: 10.1016/j.jhsa.2006.10.010.
Orive M, Anton-Ladislao A, García-Gutiérrez S, et al. Prospective study of predictive factors of changes in pain and hip function after hip fracture among the elderly. Osteoporos Int. 2016 Feb;27(2):527-36. doi: 10.1007/s00198-015-3267-y.
Binkley JM, Stratford PW, Lott SA, Riddle DL. The lower extremity functional scale (LEFS): scale development, measurement properties, and clinical application. Phys Ther. 1999 Apr;79(4):371-83. PMID: 10201543.
Lower Extremity Functional Scale (LEFS). Available from: https://drayerpt.com/content/uploads/2015/10/Lower-Extremity-LEFS.pdf. Accessed: May 03, 2018.
Mehta SP, Fulton A, Quach C, Thistle M, Toledo C, Evans NA. Measurement properties of the lower extremity functional scale: a systematic review. J Orthop Sports Phys Ther. 2016 Mar;46(3):200-16. doi: 10.2519/jospt.2016.6165.
Demetracopoulos CA, Vineyard JC, Kiesau CD, Nunley JA 2nd. Long-term results of debridement and primary repair of peroneal tendon tears. Foot Ankle Int. 2014 Mar;35(3):252-7. doi: 10.1177/1071100713514565.
Hoogeboom TJ, de Bie RA, den Broeder AA, van den Ende CH. The Dutch Lower Extremity Functional Scale was highly reliable, valid and responsive in individuals with hip/knee osteoarthritis: a validation study. BMC Musculoskelet Disord. 2012 Jul 2;13:117. doi: 10.1186/1471-2474-13-117.
Mahler E, Cuperus N, Bijlsma J, et al. Responsiveness of four patient-reported outcome measures to assess physical function in patients with knee osteoarthritis. Scand J Rheumatol. 2016 Nov;45(6):518-527. doi: 10.3109/03009742.2016.1140226.
Dingemans SA, Kleipool SC, Mulders MAM, et al. Normative data for the lower extremity functional scale (LEFS). Acta Orthop. 2017 Aug;88(4):422-426. doi: 10.1080/17453674.2017.1309886.
FRAX®. Fracture Risk Assessment Tool. Available from: https://www.sheffield.ac.uk/FRAX/.
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