The Influence of Preoperative Central Sensitization on the Postoperative Prognosis of Pilon Fractures: A Retrospective Study.

Abstract

Purpose: Although surgical techniques have improved, chronic pain, functional impairment and psychological effects still occur after pilon fracture surgery. The aim of this study is to evaluate the clinical efficacy after pilon fracture surgery and to explore the impact of preoperative patients with central sensitization (Central Sensitization, CS) on the improvement of postoperative pain, function, anxiety/depression.

Patients and methods: In this single-center retrospective study, we collected adult (≥18 years old) patients with pilon fractures who underwent open reduction and internal fixation at Xi'an Honghui Hospital from January 2020 to July 2024 and had the cognitive ability to complete the questionnaire. Exclusion criteria included incomplete medical records, concurrent other foot fractures, or severe mental disorders. The preoperative central sensitization (CS) determination criteria were a score of ≥18 on the Chinese version of the 9-item Central Sensitization Inventory (CSI-9). The assessment indicators at baseline and the last follow-up included the Visual Analogue Scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society Hindfoot Score (AOFAS), and the Hospital Anxiety and Depression Scale (HADS). Patients were divided into the CS group and the non-CS group based on whether they had a preoperative central sensitization state, and the differences in baseline characteristics, pain severity, functional performance, and psychological state between the two groups were compared.

Results: At the final follow-up, the performance of the CS group was worse than that of the non-CS group, VAS was 20.04±6.87 compared to 14.15±6.34 (P < 0.001); AOFAS was 77.71±9.55 compared to 86.21±6.57 (P < 0.001); HADS-A was 6.39±2.87 compared to 3.00 (2.00, 4.00); HADS-D was 6.39±3.06 compared to 3.00 (2.00, 3.00). In terms of improvement degree, there were significant differences between the two groups in the improvement of pain and anxiety/depression (p < 0.05).

Conclusion: Both groups of patients showed significant improvement in pain relief, functional activity, and psychological state postoperatively compared to preoperatively. However, patients with preoperative CS showed less improvement in pain relief, functional recovery, and psychological state compared to those without CS. Therefore, foot and ankle surgeons should further investigate the impact of preoperative interventions for CS on postoperative outcomes in future studies.