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. 2022 Jun 1;36(6):e250-e254.
doi: 10.1097/BOT.0000000000002312.

Long-Term Trajectory of Recovery Following Pilon Fracture Fixation

Scott D Middleton  1 , Pierre Guy  1   2 , Darren M Roffey  1   2 , Henry M Broekhuyse  1   2 , Peter J O'Brien  1   2 , Kelly A Lefaivre  1   2
Affiliations

Long-Term Trajectory of Recovery Following Pilon Fracture Fixation

Scott D Middleton et al. J Orthop Trauma. .

Abstract

Objectives: To describe the trajectory of recovery following fixation of pilon fractures from baseline to 5-year follow-up.

Design: Prospective cohort study.

Setting: Level-1 trauma center.

Patients/participants: Patients with pilon fractures (OTA/AO 43.C) treated with open reduction and internal fixation.

Intervention: None.

Main outcomes measures: Patient-reported outcome measures were measured at baseline, 6 months, 1 year, and 5 years using the Short-Form 36 Health Survey (SF-36) Physical Component Score and Mental Component Score, Short Musculoskeletal Functional Assessment, and the Foot and Ankle Outcome Score.

Results: One hundred two patients were enrolled: mean age was 42.6 years; 69% were males; 88% had an injury severity score of 9; 74 patients (73%) completed 1-year follow-up; 40 patients (39%) completed 5-year follow-up. Trajectory of recovery of physical function showed a significant decline between baseline and 6 months, with significant improvement between 6 months and 1 year and then ongoing but slower improvement between 1 year and 5 years. Sixty-four patients returned to baseline SF-36 Physical Component Score at 5 years. Pain was a persistent issue and remained significantly worse at 5 years when compared with baseline. Psychological well-being (SF-36 Mental Component Score) did not significantly change from baseline at 5 years.

Conclusion: Functional recovery following open reduction and internal fixation for pilon fractures was characterized by an initial decrease in function from baseline, followed by an increase between 6 months and 1 year, and then slower but continued increases from 1 year to 5 years. Function did not return to baseline levels, pain was a persistent issue, and mental well-being showed no change from baseline at 5 years. This information may be useful when counselling patients.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

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