Injuries had to meet a certain level of severity which can be An update on the management of high-energy pilon fractures. Biz C, Angelini A, Zamperetti M, et al. to maintaining your privacy and will not share your personal information without Lippincott Journals Subscribers, use your username or email along with your password to log in. Scand J Trauma Resusc Emerg Med. 2003;85:1893–1900. BMI was only considered when reported within a range of 6 months prior to or after ORIF. 17. J Orthop Trauma. All registration fields are required. Gabbe BJ, Cameron PA, Hannaford AP, et al. 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). In addition, low income and low level of education (both beyond the scope of our study) have been reported to be associated with HRQoL after pilon fractures negatively and these factors have also been associated with higher rates of daily smoking.[7,34,35]. 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. functional outcome; ORIF; pilon fracture; quality of life; tibial fracture, You can login with your username or your email address along with your chosen password. Patients may need to use a cast boot or brace after surgery. 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. Complications after treatment of tibial pilon fractures: prevention and management strategies. 2013;74:1363–1366. 7 Months Post Op and 3 Months of “Walking”, An Update; Ankle dorsiflexion limited after 6 months post injury at 2 degrees. 2007;127:55–60. Abstract Background: Although a number of investigators have documented clinical outcomes and complications associated with tibial plafond, or pilon, fractures, very few have examined functional and general health outcomes associated with these fractures. 26. Foot Ankle Int. Worse reduction was obtained with external fixation. [3,8,15] Patients who underwent operative treatment for the pilon fracture at an outside facility, who had amputation of the operated foot or leg, who died during follow-up, were mentally impaired, or were unable to communicate in English, were excluded. 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. Supplemental digital content is available for this article. Until the bones fully heal, the patient's leg and ankle cannot be stressed or worked too hard. A tibial pilon fracture is a break at the bottom or distal portion of the tibia, more commonly known as the shinbone. 23. Active smoking status was independently associated with lower HRQoL assessed using the EQ-5D-3L. Men > women 3:1; More common in 4th decade of life; Of high-energy injuries, 30–50% are open fractures. 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). Call 911 or go to your nearest emergency room. Open reduction with internal fixation versus limited internal fixation and external fixation for high grade pilon fractures (OTA Type 43C). 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. 2018;2018: 6054021. Rios-Diaz AJ, Herrera-Escobar JP, Lilley EJ, et al. In our study, the only factor associated with worse long-term results for all outcome measures was active smoking status at the time of definitive fixation of the pilon fracture. Foot Ankle Surg. In general, worse HRQoL metrics (EQ-5D-3L scores) were proportional to FAAM and PROMIS PF scores. Osteonecrosis has been previously described after Weber C fracture-dislocations but has not been reported following fixation of pilon fractures. Evolving treatment concepts for the pilon fracture. Please try after some time. The surgeon will be focused on making sure the anatomy of the fracture … At a medium follow-up of 82 months (82 (interquartile range (IQR), 45–120), median Foot and Ankle Ability Measure was 74 (IQR, 57–82), median PROMIS PF 49 (IQR, 44–57), median EQ-5D-3L 0.81 (IQR, 0.71–0.84). Prognostic factors of health-related. Keyword Highlighting Posttraumatic arthritis is a type of arthritis that develops after an injury. One previous study has shown a correlation between general health function and region-specific patient-reported outcomes. Post-Surgery. 4. 2007;21 (10 suppl):S1–S133. Evidence of validity for the Foot and Ankle Ability Measure (FAAM). 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. Typically, the fibula (the smaller ankle bone in the lower leg, parallel to the tibia) will also break when a tibial pilon fracture … 2000;5:873–885. 2016;24:7. Bonar S, Marsh J. Tibial plafond fractures: changing principles of treatment. Pilon fractures can have significant effects on a patient's life and should therefore be seen as potentially disabling injuries. Factors associated with our outcome measures, as identified in this study, should therefore not be seen as the only factors influencing HRQoL and functionality after operative treatment of a pilon fracture and may have been confounded by factors. For more information, please refer to our Privacy Policy. Perioperative complications include malreduction, inadequate fixation, and intra-articular penetration of hardware, all of which may be minimized by preoperative planning and meticulous operative technique. Methods: A retrospective cohort analysis of pilon fractures treated at two centers between 1994 and 1995 was conducted. Injury. 2014;9:75–79. Med Care. You may initially be required to walk with an assistive device like a walker or crutches after breaking your ankle. We believe this to be due to the relatively long interval between surgery and follow-up and the potentially more transient nature of a trauma patient population. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, December 2019 - Volume 2 - Issue 4 - p e043, OTAI_2019_07_31_HENG_OTAI-D-19-00017_SDC1.docx; [Word] (17 KB), Long-term outcomes after operative treatment for tibial pilon fractures, Articles in PubMed by Quirine M.J. van der Vliet, MD, Articles in Google Scholar by Quirine M.J. van der Vliet, MD, Other articles in this journal by Quirine M.J. van der Vliet, MD. In this approach, predictors associated with the outcome by bivariate analysis were included in the multivariable regression model. 800-638-3030 (within the USA), 301-223-2300 (outside of the USA). Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in . Some error has occurred while processing your request. 19. to save searches, favorite articles and access email content alerts. Although some studies analyzed QOL after pilon fractures , , , they included a mixed of fracture types. Sequelae were present in 20 patients, mainly including chronic pain (8) and arthrosis (10). 27(7):e152-6. 24. 27(7):e152-6. Predictors excluded at the bivariate analysis state were reincorporated only if doing so reduced the overall deviance of the model. Aim of the study is to (1) propose a new classification system based … PROMIS Physical Function scores had a median of 49 (IQR, 44–57), mean PROMIS PF score was 50 (standard deviation 7.8). 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. Men > women 3:1; More common in 4th decade of life; Of high-energy injuries, 30–50% are open fractures. . The surgeon also must schedule regular visits to monitor healing of the fracture and advance the patient's activity accordingly. [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]. 2. Posttraumatic Arthritis. In: Charles A. Rockwood, Robert W. Bucholz, Charles M. Court-Brown, James D. Heckman PT, editor. Clinical outcome and changes in gait pattern after pilon fractures. Ann Surg. 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. [32,33] Adjusting with general health measures allows the region-specific injury of interest to be assessed in the right context. A pilon fracture is a type of break of the shinbone that happens near the ankle. Hill CE. Tel: +1 617-643-0149; fax: +1 617-726-8214. Patients were also invited for new clinical and radiological assessments. 2000 Jul-Aug. 8 (4):253-65. In multivariable regression analyses, higher BMI, deep infection, and lower HRQoL (assessed using the EQ-5D-3L) were found to be independently associated with worse ankle function measured with the FAAM (Table 4). Main prognostic factors of worse SF36 were fracture severity, reduction quality and arthrosis. Link to reset your password has been sent to specified email address. He can also make sure that your assistive device is properly sized for you and that you are using it properly. Complications after treatment of tibial pilon fractures can occur intraoperatively or in the early or late postoperative period. MD, PhD, FACSc; Heng, Marilyn MD, MPH, FRCSCa,∗, aDepartment of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, bDepartment of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, MA, cDepartment of Traumatology, University Medical Center Utrecht, Utrecht, The Netherlands. QOL was evaluated by the Short Form-36 questionnaire and compared to the standard in the age-matched general population. Questionnaires were administered through telephone interviews or online through a secured web link, without a clinical visit. 29. Pilon fractures of the tibia: a study based on 19 cases. The information is the property of Massachusetts General Hospital The main reason for nonresponse to follow-up by questionnaire was inability to contact the patients. HRQoL was significantly lower compared to a reference population (P < .001). In most cases, it includes breaks in both the tibia and fibula of the lower leg. [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. If you also had damaged tendons or ligaments, then those may take longer to heal. Linder F, Mani K, Juhlin C, et al. Sharing our pilon fracture experience; It has been 5 and a half months after my pilon fracture surgery. Davidovitch RI, Elkataran R, Romo S, et al. Smoking was considered positive if a patient was a current smoker at the time of surgery or quit smoking less than 2 weeks prior to the fixation. be used to longitudinally quantify loss of joint space following pilon fracture and assess the impact of … Due to the retrospective nature of this study, it was not possible to account for all variables that carry potential to influence the outcome measures. 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