Return to initial work and fulfillment of expectations in patients with complex proximal tibial fracture is influenced by physical workload and workers´ compensation status.

Abstract

The aim of this study was to investigate on the influence of physical workload and workers' compensation status on fulfillment of patients' expectations, return to initial work, and functional outcome after surgical treatment of complex proximal tibial fractures. This prospective study included 114 patients with complex tibial fractures (AO/OTA type B and C). At final follow-up, an individualized questionnaire based on the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES) was used to assess whether preoperative expectations had been met. In addition, the condition of the knee joint, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used. Physical workload was assessed using the REFA classification. Physical workload and workers' compensation status was corelated to duration of incapacity to work (weeks), fulfillment of expectations, and functional outcome. Patients with higher physical workloads showed longer incapacity to work (20.1 weeks on average) and were significantly less likely to report a complete return to their initial professional activity (r=-0.21). Their preoperative expectations were significantly less frequently fulfilled (r=-0.29). Workers' compensation status was associated with lower satisfaction and higher workload demands. Reintegration programs proved effective, enabling a high percentage of patients to return to work without restrictions (p = 0.04). Significant negative correlations were found between workload and functional outcomes (KOOS dimensions, residual pain, quality of life). Individualized, job-oriented rehabilitation with realistic expectations is crucial for improving return to work, especially for high-workload patients. Future research should integrate physical and psychosocial factors in rehabilitation strategies.