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. 2023 Jul;143(7):4149-4154.
doi: 10.1007/s00402-022-04717-6. Epub 2022 Dec 1.

Long-term analysis of chronic pain associated with lower extremity injuries

Thomas Rauer  1 , Eva Friedl  2 , Jamison G Gamble  3 , Boris A Zelle  4 , Hans-Christoph Pape  2 , Roman Pfeifer  2
Affiliations

Long-term analysis of chronic pain associated with lower extremity injuries

Thomas Rauer et al. Arch Orthop Trauma Surg. 2023 Jul.

Abstract

Introduction: The main objective of this study is to examine chronic pain and limping in relation to lower extremity and pelvic fracture location in addition to fracture combinations if multiple fractures are present on the same leg that have not been previously reported. We hypothesize that fracture pattern and location of lower extremity and pelvis fractures of multiple injured patients influence their long-term pain outcome.

Materials and methods: Retrospective cohort study. Patients with treated multiple lower limb and pelvic fractures at a level 1 trauma center and followed up for at least 10 years postinjury were assessed. Lower leg pain subdivided into persistent, load-dependent and intermittent pain, as well as limping were recorded by using self-administered patient questionnaires and standardized physical examinations performed by a trauma surgeon. Descriptive statistics were used to present comparative measurements between groups.

Results: Fifty-seven percent of patients (n = 301) showed chronic lower limb pain 10 years postinjury. Ten percent of all patients with chronic pain displayed persistent pain, and here the most common fracture combination was tibial shaft fractures in combination with femoral shaft or proximal tibial fractures (13%). One hundred fifty-one patients reported load-dependent pain, with the most common fracture combinations being fractures of the foot in combination with femoral shaft fractures or distal tibial fractures (11%). One hundred twenty patients reported intermittent pain, with the most common fracture combinations involving the shaft of the tibia with either the femoral shaft or distal tibia (9%). Two hundred fifteen patients showed a persistent limp, and here the most common fractures were fractures of the femoral shaft (19%), tibial shaft (17%), and pelvis (15%).

Conclusions: In multiple injured patients with lower extremity injuries, the combination of fractures and their location are critical factors in long-term outcome. Patients with chronic persistent or load-dependent pain often had underlying femoral shaft fractures in combination with joint fractures.

Keywords: Acetabulum; Chronic pain; Long-term outcome; Lower limb; Multiple injuries; Polytrauma.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Most common fractures of all patients with long-term pain in multiple fractures of the lower limbs presenting as A load-depending pain, B intermittent pain, C persistent pain
Fig. 2
Fig. 2
Most common fracture combination of all patients with long-term pain in multiple fractures of the lower limbs presenting as A load-depending pain, B intermittent pain, C persistent pain
See this image and copyright information in PMC

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