Robert K Wagner, Maarten van Weezenbeek, Marcos R Gonzalez, Maaz Muhammad, Adam N Musick, Austin T Gregg, Carla H Lehle, Thomas J Policicchio, Job N Doornberg, Stein J Janssen, Arun Aneja, Thuan V Ly
{"title":"股骨远端骨折固定后患者报告的结果：一项151例患者的回顾性队列研究。","authors":"Robert K Wagner, Maarten van Weezenbeek, Marcos R Gonzalez, Maaz Muhammad, Adam N Musick, Austin T Gregg, Carla H Lehle, Thomas J Policicchio, Job N Doornberg, Stein J Janssen, Arun Aneja, Thuan V Ly","doi":"10.1097/BOT.0000000000003081","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate 6-, 9-, and 12-month Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Global Health Physical (GH-Physical), and Global Health Mental (GH-Mental) scores following operative treatment of distal femur fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two Level 1 Trauma Centers.</p><p><strong>Patients: </strong>Adult patients treated operatively for a distal femur fracture (AO/OTA 33A or 33C) between 2016 and 2024, with ≥1 PROMIS score available between 3 and 12 months postoperatively were identified. Patients undergoing reoperation for nonunion were excluded.</p><p><strong>Outcome measures and comparisons: </strong>PROMIS scores were determined as estimated marginal means to account for repeated observations. Mixed-effects linear regression was performed to identify factors (e.g., patient, injury, and treatment characteristics, and PROMIS-GH-Mental scores) associated with PROMIS-PF.</p><p><strong>Results: </strong>Overall, 151 patients (median age 69 years [range: 21-84 years]; 66% female) were included. PROMIS-PF scores were 34.8 at 6 months, 36.3 at 9 months, and 37.9 at 12 months (p<0.001). PROMIS-GH-Physical scores were 40.5, 40.9, and 41.3 (p=0.35), and PROMIS-GH-Mental scores were 46.0, 46.6, and 47.2 (p=0.25). In multivariable analysis, female sex (ß: -2.7, p=0.010) and assisted baseline ambulation (ß: -4.1, p<0.001) were associated with worse PROMIS-PF scores, whereas better PROMIS-GH-Mental scores at follow-up (1-unit increase ß: 0.36, p<0.001) and follow-up duration (1-month increase: ß: 0.35, p=0.006) were associated with better scores.</p><p><strong>Conclusions: </strong>PROMIS-PF scores improved over time but remained considerably lower than the US reference population at 12 months (i.e., 38 vs. 50 points). Clinicians should educate patients that, even though their fracture is healing as expected, their physical function will likely remain impaired at 12 months. The current study findings suggest that physical function during recovery from distal femur fractures is more affected by baseline functioning and mental health during follow-up than injury characteristics.</p><p><strong>Level of evidence: </strong>Prognostic Level II.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Patient-Reported Outcomes Following Distal Femur Fracture Fixation: A Retrospective Cohort Study of 151 Patients.\",\"authors\":\"Robert K Wagner, Maarten van Weezenbeek, Marcos R Gonzalez, Maaz Muhammad, Adam N Musick, Austin T Gregg, Carla H Lehle, Thomas J Policicchio, Job N Doornberg, Stein J Janssen, Arun Aneja, Thuan V Ly\",\"doi\":\"10.1097/BOT.0000000000003081\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To evaluate 6-, 9-, and 12-month Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Global Health Physical (GH-Physical), and Global Health Mental (GH-Mental) scores following operative treatment of distal femur fractures.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two Level 1 Trauma Centers.</p><p><strong>Patients: </strong>Adult patients treated operatively for a distal femur fracture (AO/OTA 33A or 33C) between 2016 and 2024, with ≥1 PROMIS score available between 3 and 12 months postoperatively were identified. Patients undergoing reoperation for nonunion were excluded.</p><p><strong>Outcome measures and comparisons: </strong>PROMIS scores were determined as estimated marginal means to account for repeated observations. Mixed-effects linear regression was performed to identify factors (e.g., patient, injury, and treatment characteristics, and PROMIS-GH-Mental scores) associated with PROMIS-PF.</p><p><strong>Results: </strong>Overall, 151 patients (median age 69 years [range: 21-84 years]; 66% female) were included. PROMIS-PF scores were 34.8 at 6 months, 36.3 at 9 months, and 37.9 at 12 months (p<0.001). PROMIS-GH-Physical scores were 40.5, 40.9, and 41.3 (p=0.35), and PROMIS-GH-Mental scores were 46.0, 46.6, and 47.2 (p=0.25). In multivariable analysis, female sex (ß: -2.7, p=0.010) and assisted baseline ambulation (ß: -4.1, p<0.001) were associated with worse PROMIS-PF scores, whereas better PROMIS-GH-Mental scores at follow-up (1-unit increase ß: 0.36, p<0.001) and follow-up duration (1-month increase: ß: 0.35, p=0.006) were associated with better scores.</p><p><strong>Conclusions: </strong>PROMIS-PF scores improved over time but remained considerably lower than the US reference population at 12 months (i.e., 38 vs. 50 points). Clinicians should educate patients that, even though their fracture is healing as expected, their physical function will likely remain impaired at 12 months. The current study findings suggest that physical function during recovery from distal femur fractures is more affected by baseline functioning and mental health during follow-up than injury characteristics.</p><p><strong>Level of evidence: </strong>Prognostic Level II.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-09-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Trauma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BOT.0000000000003081\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000003081","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Patient-Reported Outcomes Following Distal Femur Fracture Fixation: A Retrospective Cohort Study of 151 Patients.
Objectives: To evaluate 6-, 9-, and 12-month Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Global Health Physical (GH-Physical), and Global Health Mental (GH-Mental) scores following operative treatment of distal femur fractures.
Methods: Design: Retrospective cohort study.
Setting: Two Level 1 Trauma Centers.
Patients: Adult patients treated operatively for a distal femur fracture (AO/OTA 33A or 33C) between 2016 and 2024, with ≥1 PROMIS score available between 3 and 12 months postoperatively were identified. Patients undergoing reoperation for nonunion were excluded.
Outcome measures and comparisons: PROMIS scores were determined as estimated marginal means to account for repeated observations. Mixed-effects linear regression was performed to identify factors (e.g., patient, injury, and treatment characteristics, and PROMIS-GH-Mental scores) associated with PROMIS-PF.
Results: Overall, 151 patients (median age 69 years [range: 21-84 years]; 66% female) were included. PROMIS-PF scores were 34.8 at 6 months, 36.3 at 9 months, and 37.9 at 12 months (p<0.001). PROMIS-GH-Physical scores were 40.5, 40.9, and 41.3 (p=0.35), and PROMIS-GH-Mental scores were 46.0, 46.6, and 47.2 (p=0.25). In multivariable analysis, female sex (ß: -2.7, p=0.010) and assisted baseline ambulation (ß: -4.1, p<0.001) were associated with worse PROMIS-PF scores, whereas better PROMIS-GH-Mental scores at follow-up (1-unit increase ß: 0.36, p<0.001) and follow-up duration (1-month increase: ß: 0.35, p=0.006) were associated with better scores.
Conclusions: PROMIS-PF scores improved over time but remained considerably lower than the US reference population at 12 months (i.e., 38 vs. 50 points). Clinicians should educate patients that, even though their fracture is healing as expected, their physical function will likely remain impaired at 12 months. The current study findings suggest that physical function during recovery from distal femur fractures is more affected by baseline functioning and mental health during follow-up than injury characteristics.
期刊介绍：
Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.
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