Foot fracture may predict poor patient reported functional outcomes in lower extremity reconstruction of the traumatically injured lower extremity: A case-control study.

Abstract

Background A paucity of evidence currently exists regarding factors affecting the success of lower extremity reconstruction at restoring a functional limb. We aim to determine the effect of foot fracture on outcome measures of ambulatory success after lower extremity salvage in a trauma population.Methods A retrospective chart review was performed on 63 patients presenting to an urban level 1 trauma center between 01/2007 and 01/2015 who received soft tissue coverage of a lower extremity traumatic wound. Demographics, injury, and perioperative data were recorded. Patients were administered the Lower Extremity Functional Scale (LEFS) questionnaire via phone. The LEFS is out of 80 possible points. Ambulatory success is measured on a scale of 0 to 4 across 20 activities, with 0 indicating “extreme difficulty or inability to perform activity”, and 4 indicating “no difficulty”. Functional outcomes were compared using a two-tailed two-sample unequal variances t-test.Results This study represents data on the 63 unique patients treated with vascularized flaps whom we attempted to contact. A total of 21 patients completed the LEFS questionnaire, representing an overall response rate of 33%. Responders to the surveys included 4 (19%) patients with foot fractures and 17 (81%) without foot fractures. Average total LEFS scores were significantly lower in patients with foot fractures (23.8 ± 5.9) than in patients without (36.2 ± 19.2) foot fractures (p = 0.04). With respect to the SF36 functional scale, patients with foot fractures paradoxically reported significantly higher measures of physical functioning (81 ± 11) in comparison to those without a foot fracture (59 ± 25) at a p-value of 0.02, and role limitation due to physical health (98 ± 3) versus those with no foot fracture (74 ± 37) at a p-value of 0.02.Conclusion Sustaining a foot fracture during severe traumatic injury that necessitates lower extremity reconstruction may result in significantly decreased ambulatory success scores. Fractures of the foot may predict poor patient reported functional outcomes following lower extremity reconstruction and should be considered as a factor in the pre-operative risk and benefit assessment when deciding whether to attempt reconstruction of the mangled limb.