Evaluation of functional outcome and associated factors of adult patients with closed tibial shaft fractures 24 weeks post-management in Northern Tanzania

Background: Tibial shaft fractures are common injuries that present management challenges and significantly impact functional outcomes. Understanding the management approaches and functional outcomes of these fractures is crucial for optimizing patient care. Objective: This retrospective analytical cross-sectional study aimed to evaluate the functional outcomes and associated factors in adult patients with closed tibial shaft fractures at 24 weeks post-management. Methods: A total of 242 participants with closed tibia shaft fractures were included in this study. Data on sociodemographic characteristics, fracture patterns, management approaches, and functional outcomes were also collected. This study involved all adult patients with closed tibia shaft fractures treated in the Orthopedic Department from January 2017 to December 2021. Patient files were extracted from eHMS through medical records; those who met the inclusion criteria were called through their mobile or relative phone numbers obtained from their eHMS files for clinical assessment and radiology (X-ray) examination, and those who did not meet the criteria were excluded from the study. Preoperative clinical history and X-ray images were obtained from eHMS files, and the patients’ radiographs were taken for assessment and interpretation by the radiologist, together with the researcher. The Lower Extremity Functional Scale (LEFS) was used to evaluate the functional outcomes of closed tibial shaft fractures treated conservatively. The extracted data were exported into an Excel sheet and analyzed using SPSS version 25. Descriptive statistics and χ² tests were performed to evaluate the functional outcome and associated factors of adult patients with closed tibial shaft fractures at 24 weeks post-management. Multivariate analysis was not performed because the study design and data type focused on associations rather than predictive modeling. The analysis employed descriptive statistics and χ² tests to explore relationships between categorical variables. The LEFS tool was administered in person for reachable participants and via phone interview for those living far from the center. The Swahili-translated version was validated through back-translation for clarity. Results: The study population predominantly consisted of male participants 191 (78.9%) with a median age of 43.0 years. Comminuted fractures 101 (41.7%) were the most prevalent fracture pattern observed. Conservative management was the primary approach for treating tibial shaft fractures in 190 patients (78.5%), followed by surgical management 52 (21.5%). Among the surgical approaches, intramedullary nails 32 (61.5%) were more frequently used than plate and screws fixation 20 (38.5%). Functional outcomes varied across activities, with work, housework, and school activities showing the least difficulty. Most of the patients had normal function (56.6%). The functional outcome in relation to associated factors showed statistical significance in line with age ( P = 0.0001), occupation ( P = 0.004), and history of alcohol consumption ( P = 0.002). Conclusion: This study provides insights into functional outcomes and management approaches for closed tibial shaft fractures. Conservative management is commonly employed, and intramedullary nails are the preferred surgical approach. Most patients experienced normal function in daily activities. Factors such as age, occupation, and history of alcohol consumption showed statistical significance with functional outcome. Further prospective studies with larger sample sizes and longer follow-up periods are warranted to validate these findings and guide clinical decision making. Findings should be interpreted with caution, and future prospective studies may incorporate regression analyses to adjust for confounders.