Contemporary Long-Term Patient Reported Outcomes of Pilon Fractures

Background

Pilon fractures are historically associated with suboptimal outcomes. No long-term Australian data is available on patient-reported outcomes. We hypothesised that pilon fracture long-term outcomes are inferior to Australian population norms.

Methods

A 14-year retrospective study was conducted in a Level-1 trauma centre on AO/OTA type-B/C fractures. Type-A fractures, skeletally immature, interpreter requirement and primary amputation were excluded. Demographics, injury characteristics, management and complications were collected. The primary outcome was SF-36 with adjusted Australian norms.

Results

From 127 eligible patients, 73 were included in the study (age: 46 ± 17 years; 50 [69%] males) with 8.7 ± 3.9 years follow-up. Management included ORIF 46 (61%), external fixation (EF) with staged ORIF 17 (23%), definitive EF 4 (5%) and 8 (11%) non-operative. Further surgical intervention was required in 25 (34%) patients, with the majority for hardware removal (14 [19%]). Compared with Australian SF-36 norms, the mean Physical Component Score was lower (44.7 ± 8.9 vs. 50.3, p ≤ 0.001) whereas the Mental Component Score (51.2 ± 12.5 vs. 51.2, p = 0.24) was not. Median return to work was 4.5 months (IQR 5), with 47 (87%) of the 54 employed pre-injury working at 12 months. Two (3.7%) patients did not return to work and 24 (44%) returned at a reduced capacity.

Conclusion

This study provides a contemporary reference for pilon fractures managed in Australia. Outcomes were favourable when compared internationally. These patients are likely to resume employment, often at reduced capacity, while experiencing moderate long-term impacts to their physical well-being due to persistent pain.