Table II.
Short Musculoskeletal Functional Assessment Dysfunction (primary HRQoL outcome) (n = 681).
| Factors | Mean difference (95% CI) | p-value |
|---|---|---|
| Phase I – Reduced model | ||
| Patient factors | ||
| Pre-injury QoL score (10-point increase) | 3.17 (2.25 to 4.09) | < 0.001 |
| Age (10 yr increase) | 2.14 (1.37 to 2.92) | < 0.001 |
| Male vs female | N/A | N/A |
| Race | 0.06 | |
| Black vs White | 3.72 (-1.29 to 8.73) | |
| Other* vs White | 3.98 (-0.03 to 7.99) | |
| Current smoker vs not | 4.43 (1.91 to 6.95) | < 0.001 |
| Fracture factors | ||
| Mechanism of injury | ||
| High-energy vs low-energy† | 4.09 (1.38 to 6.79) | 0.003 |
| Bilateral vs unilateral | N/A | N/A |
| Reamed vs non-reamed nail | ||
| Open | 2.44 (-1.79 to 6.67) | 0.26 |
| Closed | 0.92 (-1.84 to 3.68) | 0.51 |
| Open vs closed | ||
| Reamed | 4.74 (1.12 to 8.35) | 0.010 |
| Non-reamed | 3.21 (-0.44 to 6.85) | 0.08 |
| Additional injuries vs isolated fracture | 6.66 (4.00 to 9.32) | < 0.001 |
| AO/OTA fracture class | 0.043 | |
| B vs A | 2.72 (0.08 to 5.36) | |
| C vs A | 3.64 (0.07 to 7.21) | |
| Location of fracture | ||
| Proximal and proximal-middle vs middle | N/A | N/A |
| Distal and distal-middle vs middle | N/A | N/A |
| Treatment factors | ||
| Anticoagulants use vs none | N/A | N/A |
| NSAIDs use vs none | N/A | N/A |
| Surgical factors | ||
| Resident vs surgeon (including fellow)‡ | 2.14 (-0.24 to 4.51) | 0.08 |
| Nail material | ||
| Titanium vs stainless steel | N/A | N/A |
| No. of locking screws | ||
| ≥ 2 on both sides vs < 2 on at least one side | 3.01 (0.61 to 5.40) | 0.014 |
| Tendon split vs tendon retraction | N/A | N/A |
| Portal | ||
| Inferior vs Superior | N/A | N/A |
| Fracture gap – adjudicated | ||
| Gap ≥ 1 cm vs no gap | N/A | N/A |
| Gap < 1 cm vs no gap | N/A | N/A |
| Time from injury to surgery | ||
| Late vs early | N/A | N/A |
| Mid vs early | N/A | N/A |
| Fasciotomy at initial surgery vs none | N/A | N/A |
| Postoperative weight-bearing status | ||
| Full vs partial or non-weightbearing | N/A | N/A |
| Phase II – Post-intervention model§ | ||
| Reoperations in response to infection | 0.001 | |
| Late vs none¶ | 15.54 (4.07 to 27.01) | |
| Early vs none | 10.17 (2.48 to 17.87) | |
| Fasciotomy | ||
| Early vs none | -2.84 (-10.39 to 4.72) | 0.461 |
| Bone graft or implant exchange | < 0.001 | |
| Late vs none | 19.70 (9.00 to 30.40) | |
| Early vs none | 14.58 (5.56 to 23.59) | |
| Nonoperatively treated infection | ||
| Early vs none | -4.22 (-14.37 to 5.93) | 0.414 |
| Dynamization | 0.420 | |
| Late vs none | 5.77 (-3.68 to 15.21) | |
| Early vs none | 1.22 (-2.70 to 5.15) | |
Other includes all ethnicities except for Black and White.
High-energy includes motor vehicle accident, crush injury, blunt direct trauma. Low-energy includes fall, twist, penetrating direct trauma.
Resident becomes MD 0.77 (95% CI 2.11 to 3.66); p = 0.60 when centre is included in the model as a covariate.
The Phase II model included the baseline predictor variables from the reduced model as covariates. Phase II models also include the following covariates for adjustment: open, reamed, interaction of open with reamed, baseline SMFA Dysfunction, age, race, mechanism of injury, smoking status, isolated fracture, AO classification, resident, number of locking screws.
Early is defined as prior to eight months from initial surgery and late is defined as eight months up to one year.
N/A, not applicable; NSAIDs, non-steroidal anti-inflammatory drugs; QoL, quality of life