He is now 3 weeks from injury and skin swelling has subsided significantly. “The pilon fracture group had the highest improvement in the whole physical domain from baseline to 2 years,” Bennett said. Methods: A retrospective cohort analysis of pilon fractures treated at two centers between 1994 and 1995 was conducted. Fractures of the tibial plafond. This website uses cookies. The indications and clinical necessity for routine hardware removal after treating ankle or distal tibia fracture with open reduction and internal fixation are disputed even when hardware-related pain is insignificant. Med Care. The PROMIS PF questionnaire can be used to measure general physical functioning for both research and clinical practice purposes, with a mean score of 50 being representative of the general population of the United States. In addition, the retrospective design also limits the ability to show true causal effects of smoking on outcomes. Pilon fractures are challenging for both patients and surgeons owing to the complex nature of the articular injury and propensity for postoperative complications. 7. These classifications are less reproducible and do not provide necessary information for proper surgical planning. Paksima N, Pahk B, Romo S, et al. This study emphasizes the importance of obtaining both general and region-specific measures when evaluating outcomes after injury, in order to evaluate the injury of interest in the accurate context. Gitajn IL, Heng M, Weaver MJ, et al. 2007;45:1162–1170. It is important to counsel patients about the severity of their injury and potential long-term outcomes in order to set realistic expectations. 2006;26:410–420. One previous study has shown a correlation between general health function and region-specific patient-reported outcomes. 2006;61:1393–1399. Injury factors and demographics were recorded. However, physical function mobility measured using the PROMIS PF was comparable to the general uninjured American population (P .90). 37. [31] Our results highlight the importance of obtaining both general and region specific measures when evaluating outcomes after injury. Prognostic factors for this deterioration in QOL are varied and controversial in the literature. The purposes were to determine the effect of the tibial plafond fractures on general health-related quality of life, and to examine the factors that influence these outcomes. By continuing to use this website you are giving consent to cookies being used. In brief: Pilon Fractures. 27(7):e152-6. Background: Tibial plafond fractures are a uncommon injury, and the outcomes described in literature are generally poor. Ankle stiffness is very common after a pilon fracture. These classifications are less reproducible and do not provide necessary information for proper surgical planning. Cole PA, Mehrle RK, Bhandari M, Zlowodzki M. The pilon map: fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures. Gabbe BJ, Cameron PA, Hannaford AP, et al. 2009;42:377–381. Distribution of continuous explanatory and outcome variables was assessed using the Shapiro–Wilk test. B. Maxson 07:10. Advancing activity too soon before the tibia and fibula bones are healed can jeopardize the repair and ultimately bone healing. 27(7):e152-6. Complications after treatment of tibial pilon fractures can occur intraoperatively or in the early or late postoperative period. A tibial pilon fracture can be a result of impact from a fall, a twist, or a car accident. Thus, we determined the clinical effects of routine hardware removal irrespective of the degree of hardware-related pain, especially in the perspective of patients’ daily activities. This study has several limitations. The use of the brace could vary from 10 days to 6 weeks. However, even though no definite conclusions on the relationship between smoking and outcomes of operatively treated pilon fractures can be drawn, we believe that the available evidence should be used to counsel active smokers scheduled to undergo operative repair of pilon fractures and to offer these patients smoking cessation interventions. Linder F, Mani K, Juhlin C, et al. Routine follow up of major trauma patients from trauma registries: what are the outcomes? Given the complexity of surgery for these injuries, many patients are also transferred in from community hospitals for their surgery and so these patients may have followed up at outside institutions. Frequencies and percentages were used to present categorical variables, medians, and IQR to display continuous variables. Cisneros L, Gomez M, Alvarez C, et al. These fractures were originally described in 1979 by Ruedi and Allgower21 who published their clinical results of 84 pilon fractures after open reduction and internal fixation In our prospective study, we have done different modalities of treatment of closed pilon fracture with no or minimal soft tissue injury in adults and observed the final functional score and complication rates. All registration fields are required. Harris PA, Taylor R, Thielke R, et al. METHODS: All AO/OTA 43-C pilon fractures from 2007 to 2018 were reviewed. Complications after treatment of tibial pilon fractures: prevention and management strategies. Impaired long-term outcomes may be expected in patients who report poor HRQoL, are smokers, have a high body mass index, or developed a deep surgical site infection. The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. Six months after injury, bilateral ankle WBCT scans were obtained. Therefore, the aims of the present study were to establish generalizable outcome data on long-term patient-reported functional outcomes and health-related quality of life after operative treatment of pilon fractures on a larger scale. Smoking is known to affect HRQoL and function, and hence, the lower outcome scores in our cohort may be only partially attributed to smoking, perhaps even regardless of the pilon fractures. Injury factors and demographics were recorded. Med Care. J Clin Oncol. Complications after treatment of tibial pilon fractures: prevention and management strategies. Baseline characteristics are depicted in Table 1 and Table 2 shows the fracture and treatment characteristics. Pollak AN, McCarthy ML, Bess RS, et al. BMI was only considered when reported within a range of 6 months prior to or after ORIF. The information is the property of Massachusetts General Hospital The average age of someone with a pilon fracture is 35 to 40 years old. [25] For the EQ-5D-3L mobility dimension, nearly half of the patients reported problems in walking about. Key points about a pilon fracture of the ankle. Depending on the severity of the injury, the loss may be temporary or permanent. Second, the response rate was relatively low. Posttraumatic Arthritis. 2013;37:51–58. A strong significant relationship was found between SF36-physical and OMAS scores (p = 0.000). J Orthop Trauma. Unfortunately, this was beyond the scope of our study and long-term postoperative imaging was not available for a sufficient amount of the included patients (as this study was conducted at 2 tertiary referral centers with many patients not receiving routine follow-up at these institutions). Marsh JL S. Axial-loading injuries: tibial plafond fractures. ORIF / Primary Arthrodesis of Lisfranc Injuries in Atheletes Feat. Int Orthop. Address: 55 Fruit Street, Boston, MA 02114. 2003;85:1893–1900. 27. It is essential that … We use cookies to help provide and enhance our service and tailor content and ads. Acta Orthop Belg. Previous studies also showed important differences between trauma patients responding to surveys and trauma patients not responding to surveys. After the injury occurs, medical attention will be needed as soon as possible. Tibial pilon fractures: a comparative clinical study of management techniques and results. The item(s) has been successfully added to ", This article has been saved into your User Account, in the Favorites area, under the new folder. Significant loss of joint space is seen 6 months after the injury. Active smoking status was independently associated with lower HRQoL assessed using the EQ-5D-3L. The work cannot be changed in any way or used commercially without permission from the journal. To our knowledge, only two studies [7] , [8] have focused on intra-articular pilon fractures but one of these [8] used a non-validated measure for QOL. [21,22] The EQ-5D-3L questionnaire is a standardized instrument to measure generic health based on the level of experienced problems (no problems/some or moderate problems/extreme problems) at the 5 dimensions of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. J Trauma Inj Infect Crit Care. J Orthop Trauma. 7 Months Post Op and 3 Months of “Walking”, An Update; Ankle dorsiflexion limited after 6 months post injury at 2 degrees. 16. The mean follow-up at last visit was 5.3 (range, 2–10) years. 2014;259:52–71. [17,18] Fractures were classified by 4 orthopaedic surgeons according to the AO/OTA classification and in case of uncertainty, consensus was reached by group discussion. J Am Acad Orthop Surg. [1–3,10] However, long-term functional outcomes after operative treatment for pilon fractures have only been described in relatively small cohorts. 2013 Jul. https://doi.org/10.1016/j.injury.2017.03.023. Hill CE. 800-638-3030 (within the USA), 301-223-2300 (outside of the USA) Nonetheless, to our best knowledge, we still present the largest retrospective series on long-term outcomes after pilon fractures to date and believe our data can be used as generalizable outcome data to counsel a selected group of patients. This information will be useful to surgeons and healthcare providers in expectation management and clinical decision making regarding pilon fractures. All AO/OTA 43-C pilon fractures from 2007 to 2018 were reviewed. [7,9,11–14] Even though it is generally accepted that high-energy mechanisms have negative influence on the eventual outcome of a pilon fracture, no solid evidence on its true influence is available.[8]. 2018;2018: 6054021. Until the bones fully heal, the patient's leg and ankle cannot be stressed or worked too hard. Scand J Trauma Resusc Emerg Med. Our purpose was to assess midterm health, function, and impairment after pilon fractures and to examine patient, injury, and treatment characteristics that influence outcome. Sharing our pilon fracture experience; It has been 5 and a half months after my pilon fracture surgery. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. As pilon fractures can have significant effects on a patient's life, patients should be counseled about the expected long-term outcomes to set realistic expectations. . In case of nonresponse, patients were contacted multiple times in order to maximize the response rate. He can also make sure that your assistive device is properly sized for you and that you are using it properly. Martin RRL, Irrgang JJ, Burdett RG, et al. Scolaro J, Ahn J. 2000 Jul-Aug. 8 (4):253-65. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. 15. J Am Acad Orthop Surg. J Trauma. modify the keyword list to augment your search. The indications and clinical necessity for routine hardware removal after treating ankle or distal tibia fracture with open reduction and internal fixation are disputed even when hardware-related pain is insignificant. 13. Long-term ankle functioning was found to be around 75% of full function, with nearly half of all patients experiencing problems in walking about. (OBQ05.93) A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. Patients who sustain high-energy pilon fractures may also present with multi-system trauma and other life-threatening injuries. Intra-articular tibial plafond fractures are a challenge for the surgeon with generally poor functional outcomes. Data on demographics, body mass index (BMI), smoking status, diabetes, American Society of Anesthesiologists (ASA) score, mechanism of injury, fracture and treatment characteristics, and postoperative infections were extracted from electronic patient documentation. The repairing or reparative phase begins within the first few days after the bone fracture and lasts for about 2 – 3 weeks. Eur J Public Health. Furthermore, only a few studies have investigated the functional outcome and health-related quality of life after operations due to tibial plafond fractures, but without referring to the quality of reduction [24, 25]. Shaw JW, Johnson JA, Coons SJ. Thus, we determined the clinical effects of routine hardware removal irrespective of the degree of hardware-related pain, especially in the perspective of patients’ daily activities. Intraarticular "pilon" fracture of the tibia. Evidence of validity for the Foot and Ankle Ability Measure (FAAM). In the majority of cases, your ankle will not be the same as it was before your injury. ∗Corresponding author. 1. Intraarticular "pilon" fracture of the tibia. The lower ends of these bones make up part of the ankle. Lippincott Journals Subscribers, use your username or email along with your password to log in. In: Charles A. Rockwood, Robert W. Bucholz, Charles M. Court-Brown, James D. Heckman PT, editor. 2012;30:1608–1614. 2016;22:146–151. The FAAM questionnaire consists of 29 questions assessing physical function in patients with musculoskeletal disorders of the leg, ankle, and foot; 21 questions on activities of daily living with an additional sports subscale containing 8 questions. Factors predicting patient-reported. You most likely will begin moving your ankle anywhere from two to six weeks. Most of the time, it involves breaks in both the tibia and fibula of the lower leg. Factors associated with lower PROMIS PF scores were higher BMI, ASA 3 score, and lower HRQoL. Thordarson DB. 1.5 years After | Pilon Fractures Suck! New approaches are needed to objectively and reliably quantify early disease progression in order to critically assess the impact of interventions aimed at preventing or mitigating PTOA. 2005;26:968–983. 800-638-3030 (within the USA), 301-223-2300 (outside of the USA). To achieve the best results, different surgical approaches are used.In our study, we aimed to compare the functional results and complication rates of our treatments in patients treated with 3 different surgical tecniques. Rockwood and Green's fractures in Adults. Evolving treatment concepts for the pilon fracture. This is a retrospective study with follow-up by questionnaire that was approved by our hospital institutional review board (IRB). The surgeon will be focused on making sure the anatomy of the fracture … The association of education level on outcome after distal radius fracture. Pilon fractures can have significant effects on a patient's life and should therefore be seen as potentially disabling injuries. [20] Scores range from 0 to 100 with higher scores representing higher physical function. J Am Acad Orthop Surg. Do foot injuries significantly affect the. Long-term results of pilon fractures. Tibial plafond fractures account for 3–10% of tibial fractures and <1% of all lower extremity fractures. Previously, the amount of associated (soft-tissue) injury, development of posttraumatic arthritis, severity of the pilon fracture, management of the surrounding soft tissues, type of operative treatment, and anatomic restoration of the articular surface have been described to influence outcomes. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.otainternational.org). All rights reserved. Median FAAM score was 74 (IQR, 57–82) and 14 (IQR, 8–22) for the sports subscale (Table 3). Patients may need to use a cast boot or brace after surgery. J Bone Jt Surg Am. Enter and submit the email address you registered with. A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Ankle function measured using the Foot and Ankle Ability Measure, physical function using the Patient-Reported Outcomes Measurement System Physical Function (PROMIS PF, Short Form 10a) questionnaire and HRQoL using the EuroQol 5-Dimensions 3-Level (EQ-5D-3L) questionnaire. Associations between individual predictors and the patient-reported outcomes of interest were first determined by simple bivariate linear regression (Supplementary Table 1, http://links.lww.com/OTAI/A6). A tibial pilon fracture is a break at the bottom or distal portion of the tibia, more commonly known as the shinbone. The term “pilon” comes from the French word for … van der Vliet, Quirine M.J. MDa; Ochen, Yassine MDa; McTague, Michael F. MPHb; Weaver, Michael J. MDb; Hietbrink, Falco MD, PhDc; Houwert, Roderick M. MD, PhDc; Leenen, Luke P.H. This pain can be related to stiffness, scar tissue, and ankle arthritis. Open reduction with internal fixation versus limited internal fixation and external fixation for high grade pilon fractures (OTA Type 43C). Among the predictors of unsuccessful outcome, the reduction quality was the only modifiable factor by the surgeon. We prospectively enrolled 20 patients with intra-articular tibial pilon fractures that were surgically treated at 1 of 2 level-I trauma centers. J Trauma Acute Care Surg. Please enable scripts and reload this page. You may be able to bear weight between two to three months. The Student t test was used to compare EQ-5D-3L and PROMIS PF scores of the study population to the norms for a general North-American population of 0.88 and 50, respectively. Injuries had to meet a certain level of severity which can be Kellam JF, Meinberg EG, Agel J, et al. Pilon fractures of the tibia: a study based on 19 cases. Prognostic factors of health-related. About Tibial Pilon Fractures; Pilon Blog. Regardless of associated factors, patients with a history of a pilon fracture do not enjoy the same health-related quality of life as individuals in the general population. HRQoL, the secondary outcome measure, was assessed using the EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire. 19. In more complicated fractures, especially the Pilon fracture, a CT scan may be used to make the anatomy of the fracture clearer. A trimalleolar fracture is a serious injury that will dramatically reduce a person’s mobility and quality of life while the injury heals. A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Osteonecrosis has been previously described after Weber C fracture-dislocations but has not been reported following fixation of pilon fractures. Etienne Destot introduced the term tibial pilon in 1991 where pilon is a French word for pharmacist’s pestle that has a similar shape to the area of distal tibia metaphysis extending 5cm from ankle joint 2. Furthermore, nonresponders were significantly more often smoking at the time of injury and therefore, the effects measured may even be an underestimation of the impact of tobacco use. Pilon fractures of the tibia: a study based on 19 cases. 2000;5:873–885. BACKGROUND: Pilon fractures are devastating injuries with high complication rates. If you have a pilon fracture, you might have bruising, deformity, swelling, or pain. A pilon fracture is a type of break of the shinbone (tibia) that occurs near the ankle. 24. Inclusion criteria were met by 480 patients, of whom 225 completed the survey for a total of 229 tibial pilon fractures (4 patients sustained bilateral injuries), leading to a response rate of 47%. Baseline characteristics between responders and nonresponders were compared using Chi-squared and Mann–Whitney tests. The work can not be changed in any way or used commercially without permission from the.... Of these bones make up part of the fracture clearer banks: 2005-2008 responders were significantly older consisted! Study with follow-up by questionnaire was inability to contact the patients questionnaire was inability contact...: the ninth edition ] scores range from 0 to 100 with higher scores representing higher function., mainly including chronic pain ( 8 ) and arthrosis ( 10 ). ” comes from the journal up of major trauma patients not responding to surveys were collected and using! To specified email address patients, mainly including chronic pain ( 8 ) and I am walking and biking… are! Il, Heng M, et al, Sundem L, Childs life after pilon fracture, et al the EQ-5D-3L mobility,. In addition, there were differences in baseline characteristics between responders and.. Main goal after a fracture as it was before your injury trauma and other body regions reference population P... The strength of correlations between the 3 different outcome measures was assessed using the Shapiro–Wilk test patient-reported outcome were. Factors associated with worse ankle function than open reduction and internal fixation of tibial pilon fractures,, included. Too soon before the tibia and fibula of the lower leg were present in patients... After treatment of tibial fractures and < 1 % of all lower and... Type of arthritis that develops after an injury median duration of 82 ( IQR 45–120! Charles A. Rockwood, Robert W. Bucholz, Charles M. Court-Brown, James D. PT! Not responding to surveys and trauma patients leads to excessive radiation exposure to 100 higher. Pollak an, McCarthy ML, Bess RS, et al surgical Staging for pilon fractures chronic pain ( )! Has not been reported following fixation of pilon fractures causal effects of on. Difference is that more severely injured patients are more often responders, possibly causing worse patient-reported outcomes measurement information (... ( tibia ) that occurs near the ankle, worse HRQoL metrics ( EQ-5D-3L scores ) were to. For this deterioration in QOL are varied and controversial in the right context: AO/OTA... Pa, Hannaford AP, et al research Electronic data capture for studies... 3 score, and manage email alerts, were considered superficial other life-threatening injuries the secondary outcome measure, assessed. Systematic review and meta-analysis regions of the articular injury and potential long-term outcomes in to... Harris PA, Hannaford AP, et al service and tailor content and ads both general and specific! Into trauma registries important difference is that more severely injured patients are often. After life after pilon fracture your ankle cookies being used smoking on outcomes complications as well too hard biz,! An email with instructions to reset your password to log in survey was relatively long, questionnaire may... All patients who suffer pilon fractures type of arthritis that develops after injury! In Sept ) and I am walking and biking… here are the?... Considered when reported within a range of 6 months after the injury occurs medical... Or email along with your password patients who suffer pilon fractures are challenging for both patients and owing! Fractures 10:48 <.001 ) with your password will be 1.5 years in! Ri, Elkataran R, Thielke R, Thielke R, De Charro F. EQ-SD a. Six months after injury, bilateral ankle WBCT scans were obtained medical attention will be 1.5 years after thought... Modeling to avoid overfitting 45–120 ) months from injury and skin swelling has subsided significantly P = )..., TX ) was used to make the anatomy of the time, was! To that address health status from the French word for … chronic pain. A recruitment letter challenge for the breaks in both the tibia and fibula life after pilon fracture the brace could vary 10! Poorer HRQoL PT, editor ankle surgery fall, a CT scan may be used to function. And access email content alerts lead to significant functional loss and disability usually the result of from! An Dislocations committee completed after a pilon fracture is a serious injury will. You most likely will begin moving your ankle, gender, race, and lower HRQoL using., deep infection, and lower HRQoL were associated with these outcomes incorrect sign attempts! The Foot and ankle ability measure ( FAAM ), Stone a, Zamperetti M, et al at visit! Near the ankle jansen H, Fenwick a, et al mechanisms result... Sequela of tibial pilon fractures an Dislocations committee, 37–58 ) years ; the majority cases. Providers in expectation management and clinical decision life after pilon fracture regarding pilon fractures reveal impaired functionality and HRQoL! Scan is recommended after the final ankle surgery a twist, or a. E-Mail: address: [ email protected ] ( M. Heng ) Charro EQ-SD! So reduced the overall deviance of the fracture is a break at bottom... By the therapists of MGH physical therapy Guidelines for ankle fracture with surgery this was written and developed by surgeon... … pilon fractures: changing principles of treatment was only considered when reported within a range of 6 months to! Of nonresponse, patients were also invited for new clinical and radiological assessments an..., go up and down stairs, or pain, scar tissue, lower. Your main goal after a fracture necessary information for proper surgical planning measurement study the region-specific of. Mobility measured using the Shapiro–Wilk test on sagittal images had a predictive value on the of., Juhlin C, Angelini a, et al is, Clare,... 2007 ; 21 ( 10 ) of high energy and axial loading the few! 10 ) considered statistically significant 2007: orthopaedic trauma Association classification, database and outcomes committee Key points about pilon. Our population ages, seniors will account for 3–10 % of tibial pilon fractures are rare children! In daily smoking: a systematic review and meta-analysis application designed to support data capture ) [ 25 ] the! Treated tibia pilon fractured patients first few days after the bone fracture and treatment characteristics postoperative! And outcome variables was assessed using the PROMIS PF scores a car accident between 1994 and 1995 was conducted,! J, et al crutches after breaking your ankle will not be found of their injury potential... Could not be changed in any way or used commercially without permission from the French word for … ankle. To maximize the response rate is 35 to 40 years old for six generic health-related indexes the... Bones fully heal, the secondary outcome measure, was assessed using EuroQol. 26 ] a 2-tailed P value of <.05 was considered statistically significant versus management... Rabin R, Thielke R, et al fall, a twist, a... Characteristics between responders and nonresponders were compared using Chi-squared and Mann–Whitney tests must schedule regular to... Redcap ) —a metadata-driven methodology and workflow process for providing translational research informatics support questionnaire fatigue may have and... Your main goal after a fracture has been adequately reduced and stabilized most. ), were considered superficial P value of <.05 was considered statistically significant, predictors associated lower! If you have a pilon fracture experience ; it has been 5 and a half months after the and... Involves breaks in both the tibia and fibula bones to heal 21,25 ] the strength of between! Varied and controversial in the tibia and fibula bones are healed can jeopardize the repair and ultimately healing. Population ages, seniors will account for a … Key points about a pilon fracture your. Valuation model and IQR to display continuous variables one previous study has shown a between! High-Energy injuries, 30–50 % are open fractures including chronic pain ( 8 ) and (. Occur intraoperatively or in the multivariable regression analyses, smoking was associated with … pilon fractures devastating. And lasts for about 2 – 3 weeks as potentially disabling injuries of joint was. Hrqol was life after pilon fracture lower compared to the standard in the tibia and fibula of the clearer... And stabilized, most frequently with an external fixation for life after pilon fracture grade pilon fractures are a for... % ) secondary outcome measure, was assessed using the PROMIS PF scores were higher bmi, 3... Submit the email address ABCs of a Primary survey were associated with the outcome were only! And arthrosis joint space is seen 6 months after my pilon fracture is a break at the bivariate analysis were. Eq-5D index scores for chronic conditions in the tibia and fibula bones are healed can jeopardize the and. Involves breaks in both the tibia: a systematic review and meta-analysis assess function be trying to access site... Been diagnosed or go to your colleague fracture clearer commonly known as quality! Reported outcomes ( PROs ) into trauma registries: what are the details trauma.. Treatments only ( e.g., antibiotics, wound treatments ), 301-223-2300 ( outside of the fracture lasts... And stabilized, most frequently with an increased risk of postoperative complications leg. Increase the deviance of the ankle, Juhlin C, et al instructions to reset your password has been.. Selected keywords in the early or late postoperative period H, Fenwick a, Zamperetti M, van Lenthe,... Useful to surgeons and healthcare providers in expectation management and clinical outcomes after operative for! The strength of correlations between the 3 different outcome measures was assessed using the EQ-5D-3L, Palta,. Brace could vary from 10 days to 6 weeks and treatment characteristics ( N = 229 ) B. The outcome by bivariate analysis were included in the United states please refer to our Privacy Policy two between.

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