QUALITY-OF-LIFE ASSESSMENT OF PATIENTS WITH POSTTRAUMATIC FRACTURE NONUNION, CHRONIC REFRACTORY OSTEOMYELITIS, AND LOWER-EXTREMITY AMPUTATION

One hundred nine patients with long-bone fracture nonunion, chronic re fractory osteomyelitis, and posttraumatic amputation were evaluated to assess the impact of chronic disability on the quality of life. The q uality of life parameters were defined by a functional assessment inst rument, the Arthritis Impact Measurement Scale (AIMS), and a Psychosoc ial Adjustment to Illness Scale (PAIS). A spouse PAIS self-report inst rument was administered to assess the psychosocial adjustment of spous es or significant others. A final questionnaire was developed to deter mine the reasons, in order of their importance, for either continuing medical therapy or accepting amputation. The PAIS scores differed sign ificantly between osteomyelitis patients and nonunion or amputation pa tients. The presence or absence of pain produced significant differenc es in AIMS and PAIS scores of nonunion and osteomyelitis patients. Sub scale analysis of AIMS scores showed significant differences among the three groups with respect to health perception and scale of orthopaed ic problem. The osteomyelitis patients were more severely affected tha n the nonunion or amputation patients. The PAIS was unable to detect a ny statistically significant differences in psychosocial adjustment of the spouses of patients in each of the three population groups. The m ost frequent reason for continuing medical and surgical management of nonunion and osteomyelitis was hopeful expectation for cure. The group who chose amputation did so in an attempt to put an end to the need f or medical and surgical treatment. Differences in psychosocial and fun ctional ability were related to disease diagnosis, pain, status of fra cture healing, and timing of amputation. This study provides further i nsight into the quality of life experience for patients with long-term orthopaedic problems.