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Five-year follow-up shows persistent disability after operative treatment for complex lower limb fracturesFive-year follow-up shows lasting challenges after complex leg fractures

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Key Takeaway
Consider that patients may not regain preinjury function after complex lower limb fracture surgery.

This secondary analysis of a five-year follow-up from an RCT population studied 868 adults aged 16 years or older with complex lower limb fractures treated operatively at 24 UK hospitals. The primary outcome was the Disability Rating Index (DRI), with secondary outcomes including health-related quality of life (EQ-5D-5L) and incidence of neuropathic pain (DN4 questionnaire).

At one year, patients showed marked improvements in DRI and EQ-5D-5L scores. However, there was little improvement in these measures thereafter through the five-year follow-up. For neuropathic pain, almost all patients who reported it at one year continued to experience persistent pain at five years.

Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported. Key limitations include the secondary analysis design and the absence of a reported comparator group. The findings describe associations, not causation, based on observational follow-up data from an RCT population.

In practice, this evidence suggests that patients are unlikely to return to their preinjury health state in the medium term after complex lower limb fractures. Clinicians should interpret these results cautiously, without inferring causation or recommending specific treatments based on this secondary analysis.

A five-year follow-up of adults who had surgery for complex lower limb fractures in the UK found that major improvements in function and quality of life mostly happened in the first year after the operation. After that first year, patients saw very little additional progress. The study followed 868 patients from 24 hospitals.

Researchers measured disability using the Disability Rating Index and quality of life with the EQ-5D-5L questionnaire. Both showed marked gains at the one-year mark, but these gains held steady without much change over the next four years. This suggests a plateau in recovery after the first year.

A key concern was neuropathic pain. Nearly all patients who reported this type of pain at one year still had it at the five-year mark. This highlights a long-term challenge for many patients after these serious injuries.

The study has important limits. It is a secondary analysis with no comparison group, so it cannot prove what caused these outcomes. The findings describe patterns seen in this group of patients.

For patients and doctors, this means realistic expectations are important. While surgery helps a lot in the first year, a full return to pre-injury health is unlikely in the medium term for many people.

What this means for you:
After complex leg surgery, most improvement happens in year one, with lasting pain and disability common.

Study Details

Study typeRct
Sample sizen = 67
EvidenceLevel 2
Follow-up192.0 mo
PublishedMay 2026
View Original Abstract ↓
AIMS: Complex fractures of the lower limb are serious injuries, but little is known about longer-term recovery. The aim of this study was to report disability, pain, and health-related quality of life (HRQoL) of patients with different fracture types up to five years after operative treatment for complex lower limb fractures. METHODS: This study involved secondary analysis of fracture types in the follow-up study of the Wound Healing in Surgery for Trauma (WHIST) trial population. Adults aged ≥ 16 years with complex fractures of the lower limb who received operative treatment at 24 hospitals in the UK were followed up for five years after surgery. The primary outcome was the Disability Rating Index (DRI). Secondary outcomes were HRQoL (EuroQol five-dimension five-level (EQ-5D-5L) questionnaire), and the incidence of neuropathic pain using the Doleur Neuropathique Questionnaire (DN4). RESULTS: The study cohort comprised 868 patients who completed at least one set of outcome data of the long-term follow-up study and had fracture type data available. The fracture distribution of the study cohort was acetabulum n = 67 (7.8%), hip n = 249 (28.7%), femur diaphysis n = 119 (13.7%), distal femur n = 72 (8.3%), tibia diaphysis n = 82 (9.4%), proximal tibia n = 193 (22.2%), distal tibia n = 40 (4.6%), and tibia plafond n = 46 (5.3%). There were marked improvements in DRI and EQ-5D-5L across all fractures at one year, but little improvement thereafter. Almost all patients who reported neuropathic pain at one year continued to experience persistent pain at five years. CONCLUSION: In this secondary analysis of the five-year follow-up study, we observed a similar pattern of recovery across all lower limb fractures. The high levels of disability and lower QoL experienced by patients in the year after their injury are persistent, and patients are unlikely to return to their preinjury health state in the medium term.
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