Abstract:
Background: Femur shaft fractures are common injuries in orthopedic trauma. Their
treatment is generally by surgical means, but their outcome may differ between the surgeon‟s
and the patient‟s perspective. Numerous studies have shown that even properly managed femur
shaft fractures result in decreased physical function and quality of life, and only patients are the
most accurate in describing their own symptoms, pain, function, and quality of life.
Methods: This study used mixed quantitative and qualitative methods to understand
perceptions about the outcomes for adult patients (18years and above) operated at CHUK for
femur shaft fracture with at least 6 months period of post-surgery. We used PROMIS tool a 10-
items 5 points Likert Scale which is used to have a feedback from patients on how health
services delivery and intervention have affected their quality of life, daily function and
symptoms of severity. Demographic data such as age and gender were collected. Internal
reliability was measured using Cronbach‟s alpha and validity tested using principal components
analysis. The association between patient satisfaction and other categorical variables was
analyzed and tested using Kruskal Wallis test. A comparison using T-test was performed for
locked-nail and other methods.
Results: A total of 83 patients operated for femur shaft fractures were included in the study.
The mean age of patients was 30.8 (std dev 7.8) years, Male to female ratio was 3.6:1, All the 10
items of PROMIS had positive inter-items correlation ranging from 0.3 to 0.9 (mean 0.53) with
high internal consistency reliability (Cronbach alpha 0.933); two principal components had
eigenvalues greater than 1 and explained 75% and more of the variation in the data. The overall
patient‟s satisfaction was very good with mean total scores of 43.7/50, with male slightly more
satisfied than female (mean total scores of >45, 44 out of 50 respectively) but this was not
statistically significant. Preoperative immobilization with traction; reduced preoperative waiting
time; surgery with closed method locked intramedullary nail were factors associated with better
patient reported outcome.
Conclusion: The patient reported outcome after femur shaft fracture surgery is very good with
overall satisfaction 43.7/50 and PROMIS is a valid and reliable tool for patient reported outcome
in our settings and our findings are consistent with most of published studies. Implementation or
routine use of this tool will improve the patient-centered care based on perception of outcome.
