Nicoll evaluated 705 patients with fractures of the tibial shaft. He identified a number of factors determining the quality of the clinical outcome. The author is from Mansfield, England.
Parameters:
(1) stiffness in the ankle (loss of extension or flexion)
(2) stiffness in the tarsus
(3) stiffness in the knee
(4) anterior or posterior bowing
(5) valgus or varus angulation
(6) rotational deformity
(7) shortening of the leg
|
Parameter |
Finding |
Severity |
|
stiffness in the ankle |
none |
none |
|
|
1 - 25% loss of flexion or extension |
functionally insignificant |
|
|
26 - 50% loss of flexion or extension |
moderate |
|
|
decrease functional range > 50% |
severe |
|
stiffness in the tarsus |
none |
none |
|
|
1 - 25% loss of inversion or eversion |
functionally insignificant |
|
|
26 - 50% loss of inversion or eversion |
moderate |
|
|
decrease functional range > 50% |
severe |
|
stiffness in the knee |
none |
none |
|
|
1 - 10% loss of flexion |
functionally insignificant |
|
|
any loss of extension; 11-50% loss of flexion |
moderate |
|
|
decrease functional range > 50% |
severe |
|
anterior or posterior bowing |
0 |
none |
|
|
1 - 9° |
functionally insignificant |
|
|
10 - 20° |
moderate |
|
|
> 20° |
severe |
|
valgus or varus angulation |
0 |
none |
|
|
1 - 9° |
functionally insignificant |
|
|
10 - 20° |
moderate |
|
|
> 20° |
severe |
|
rotational deformity |
0 |
none |
|
|
1 - 9° |
functionally insignificant |
|
|
10 - 20° |
moderate |
|
|
> 20° |
severe |
|
shortening |
0 |
none |
|
|
|
functionally insignificant |
|
|
|
moderate |
|
|
> 2 cm |
severe |
where:
• Functionally insignificant indicated something that could be detected by the examiner but not appreciated by the patient.
Specialty: Surgery, orthopedic
