Functional Outcomes and Complications in Polytrauma Patients With Long Bone Fractures: A Prospective Observational Cohort Study

Abstract

Background: Long-bone fractures in polytrauma are markers of high-energy injury and can prolong dependence even after survival. This study evaluated functional recovery, complications, and factors associated with six-month function among adults with polytrauma and long-bone fractures.
Methods: In this prospective observational cohort model, 180 adults with an Injury Severity Score (ISS) of at least 16 and one or more acute long-bone fractures were enrolled at a tertiary trauma centre. Patients were managed using physiology-guided early appropriate care or staged damage-control orthopaedics. Functional Independence Measure (FIM) scores were recorded at admission, discharge, three months, and six months. Major complications, fracture union, ambulation, return to work, and mortality were assessed. Multivariable linear regression identified predictors of six-month FIM, and logistic regression examined factors associated with major complications.
Results: The mean age was 39.3 ± 13.6 years, 145 (80.6%) patients were male, and road traffic collisions accounted for 136 (75.6%) injuries. Mean ISS was 23.6 ± 6.0. Multiple long-bone fractures occurred in 75 (41.7%) patients and 68 (37.8%) had open fractures. Definitive fixation was completed within 36 hours in 81 (45.0%) patients. Major complications occurred in 68 (37.8%), including surgical-site infection in 22 (12.2%), pulmonary complications in 28 (15.6%), delayed union or nonunion in 16 (9.8% of six-month survivors), and unplanned reoperation in 20 (11.1%). Eight patients died in hospital (4.4%). Among 164 patients completing six-month follow-up, mean FIM improved from 52.0 at admission to 113.1 at six months (P < 0.001); 129 (78.7%) regained independent ambulation and 84 of 129 previously employed patients (65.1%) returned to work. Higher age, ISS, severe traumatic brain injury, open fracture, and major complications independently predicted lower six-month FIM, while definitive fixation within 36 hours was associated with a 3.7-point higher adjusted FIM score.
Conclusion: Polytrauma patients with long-bone fractures showed substantial functional recovery, but more than one-third experienced a major complication. Physiological severity, neurological injury, open fractures, and postoperative complications were the principal determinants of persistent disability. Timely definitive fixation after adequate resuscitation and structured rehabilitation may improve recovery, although causality should be confirmed in multicentre studies.