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Objective: To calculate the minimal clinically important differences (MCIDs) of patient-reported outcomes measurement information system physical function (PROMIS PF) scores for patients with operatively treated tibial shaft fractures.
Design: Retrospective Cohort Study.
Setting: A Level 1 trauma center.
Patients: All operatively treated tibial shaft fractures identified by Current Procedural Terminology codes.
Intervention: Enrolled patients treated acutely with operative fixation of their tibia.
Main Outcome Measurements: MCIDs were calculated by distribution-based and anchor-based methods, calculated from PROMIS PF scores completed at least at two-time points postoperatively. MCIDs were calculated at different time points including overall, 7-12 weeks, 3-6 months, and 6-24 months. MCIDs were calculated for different subgroups including open fractures, closed fractures, any complications, and no complications.
Results: MCID for PROMIS PF scores was 5.7 in the distribution-based method and 7.84 (SD 18.65) in the anchor-based method. At 6-24 postoperatively, the months the distribution-based MCID was 5.95 from a postoperative baseline 27.83 (8.74) to 42.85 (9.61), P < 0.001. At 6-24 months, the anchor-based MCID was 10.62 with a score difference between the improvement group of 16.03 (10.73) and the no improvement group of 5.41 (15.75), P < 0.001. Patients with open fractures (distribution-based 6.22 and anchor-based 8.05) and any complications (distribution-based 5.71 and anchor-based 9.29) had similar or higher MCIDs depending on the methodology used than the overall cohort MCIDs.
Conclusion: This study identified distribution-based MCID of 5.7 and anchor-based MCID of 7.84 calculated from PROMIS PF scores in operative tibial shaft fractures. Distribution-based methods yielded smaller MCIDs than anchor-based methods. These MCID scores provide a standard to compare clinical and investigational outcomes.
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http://dx.doi.org/10.1097/BOT.0000000000002600 | DOI Listing |
JB JS Open Access
September 2025
Center for Orthopaedic Injury Research and Innovation, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
Background: Patient-reported outcome measures are increasingly common in orthopaedic research yet routinely fail to detect clinically meaningful differences in clinical trials. We assessed if orthopaedic studies are more likely to detect clinically important differences with a binary outcome, such as nonunion surgery, or a continuous patient-reported outcome sensitive to important clinical differences.
Methods: We constructed a hypothetical clinical trial comparing 2 treatments for tibial shaft fractures.
Orthop Res Rev
September 2025
Department of Orthopaedic Surgery, The Royal Brisbane and Women's Hospital, Brisbane, Australia.
Treatment guidelines for open tibial fractures are well established in high-income countries, but their implementation in low-resource settings remains challenging. To date, only one African country has attempted to formulate national, consensus-based guidelines that cover key aspects such as antibiotic administration, initial stabilization, surgical debridement, wound management, and definitive fixation. This narrative review summarizes current principles for the initial management of open tibial shaft fractures and evaluates their relevance in the Southern African context, particularly in rural and resource-constrained environments.
View Article and Find Full Text PDFAm J Case Rep
September 2025
Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan.
BACKGROUND Periprosthetic tibial fractures following total knee arthroplasty (TKA) are increasingly encountered in very elderly patients, where multiple comorbidities and osteoporosis compromise early mobilization and elevate the risk of complications. Maintaining pre-injury activities of daily living (ADL) while ensuring safe surgical management is challenging. We present a case of a 95-year-old woman with a periprosthetic tibial shaft fracture managed with open reduction, additional plate fixation, and Ilizarov external fixation, enabling immediate postoperative weight-bearing.
View Article and Find Full Text PDFArthroscopy
September 2025
Atrium Health Wake Forest Baptist Hospital. Electronic address:
The posterior tibial slope, used to define the angulation of the tibial plateau relative to the tibial shaft, is an important radiographic measurement that has gained significant interest recently. Increasing biomechanical and clinical literature has demonstrated the importance of evaluating posterior tibial slope due to its impact on knee kinematics. Although risk of anterior cruciate ligament (ACL) injury and graft rupture is multifactorial, studies have demonstrated that increased posterior tibial slope is likely a contributing factor.
View Article and Find Full Text PDFBone Joint Res
September 2025
Legal Medicine Research Center, Iran Legal Medicine Organization, Tehran, Iran.
Aims: The significance of periosteal vessels in the healing of tibial shaft fractures is well-established. However, the gross anatomical patterns and differential distribution of these vessels on the medial versus lateral surface of the tibial shaft have not been thoroughly described. This study aimed to illustrate the comparative anatomy of periosteal circulation on the medial versus lateral surface of the tibial shaft, where tibial plates are commonly applied.
View Article and Find Full Text PDF