Extract
To The Editor:We found "Long-Term Outcome After Tibial Shaft Fracture: Is Malunion
Important?" (2002;84:971-80), by Milner et al., to be quite interesting,
but we think that any retrospective study involving the long-term follow-up of
malunited fractures is fundamentally flawed by an inherent bias in patient
selection. The residual angulation after a fracture heals is either acceptable
or unacceptable to both the patient and the treating physician. When it is
judged to be unacceptable, it is corrected either for functional or cosmetic
reasons. Alternatively, substantial radiographic angulation may be compensated
for by adaptations of gait or a reduction in activity level1. If at
some later point the limb becomes symptomatic, reliable forms of treatment are
again readily available. It would, therefore, be very unusual for a malunited
limb with substantial deformity to develop degenerative arthropathy and not be
corrected.