Magida N1, Myezwa H2, Mudzi W3
1University of Pretoria, Department of Physiotherapy, Pretoria, South Africa, 2University of Witwatersrand, Department of Physiotherapy, Johannesburg, South Africa, 3University of Free State, Post Graduate School, Bloemfontein, South Africa

Background: Non-union fractures are known to impact negatively in activities of daily living and socio-economic aspects of patients. There is a dearth of research data reported on clinical pathways of these patients from hospital until discharge and their final outcomes following lower limb non-union fractures. There is a need to gain more insight into the patients' quality of life from hospital admission right through discharge as non-union fractures require long term management.

Purpose: We aimed to establish the quality of life of lower limb non-union fracture patients, with a view to determine their clinical pathways following their hospital stay.

Methods: A quantitative research approach involving a survey design and case study method was used to investigate the quality of life and clinical pathways of non-union fracture patients. A clinical pathways' questionnaire was initially used to collect data of patients' hospital admission records. A standardised Short form 36 questionnaire was used to assess the quality of life of the identified lower limb non-union fracture patients. Clinical pathways questionnaire also collected data including date of admission and non-union fracture diagnosis, associated co-morbidities, and other health-care practitioners' involved in the management of these patients. Frequency of follow-up hospital visits, and patient participation in activities of daily living within a six month period was also established. The Kruskal-Wallis test, was used to analyse data from Short Form-36 to yield different health status domains in terms of quality of life of the patients. Each domain was compared to the type of non-union fracture incurred. Frequency of follow up visits, length of hospital stay, nature of therapy used and mobility status of patients on discharge were analysed using median and interquantile ranges.

Results: We found that most patients diagnosed with lower limb non-union fractures were below 60 years of age (n=21), single (n= 12), unemployed (n=15) and were smokers (n=19). Atotal of four patients had non-union fractures for more than two years. Majority of patients (n=19) had tibia non-union fractures. The median length of hospital stay was four months. There was a significant impact of lower limb non-union fractures on the role emotional (p=0.03) and physical health (p=0.0001). During the six months of follow up, 12 lower limb non-union fracture patients were re-admitted. Patients above 60 years were less prevalent in lower limb non-union fractures. All the patients (n=22) experienced impairment, reduced activity and participation level due to lower limb non-union fractures and two patients had lower limb amputation as a final outcome.

Conclusion(s): In this study, we found that patients' physical health and role emotional is affected by lower limb non-union fractures, therefore it was imperative that clinical pathways be established to identify functional outcome of these patients.

Implications: Holistic approach in clinical pathways for lower limb non-union fracture patients may reduce costs in hospital stay, and create more efficient systems to prevent complications associated with lower limb non-union fractures.

Keywords: clinical pathways, non-union fractures, quality of life

Funding acknowledgements: The study was funded by Enraf Mediotronics

Topic: Musculoskeletal: lower limb

Ethics approval required: Yes
Institution: University of Witwatersrand and University of Pretoria
Ethics committee: Human Resource Ethics Committee
Ethics number: M 150236; 349/2017

All authors, affiliations and abstracts have been published as submitted.

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