Long-term outcomes after operative treatment for tibial pilon fractures. Issue 4 (December 2019)

• Record Type: Journal Article
• Authors: van der Vliet, Quirine M.J.; Ochen, Yassine; McTague, Michael F.; Weaver, Michael J.; Hietbrink, Falco; Houwert, Roderick M.; Leenen, Luke P.H.; Heng, Marilyn
• Is Part Of: OTA international. Volume 2:Issue 4(2019)
• Publication Date: 2019-12
• Subjects: functional outcome -- ORIF -- pilon fracture -- quality of life -- tibial fracture
• DOI: 10.1097/OI9.0000000000000043
• Languages: English
• ISSNs: 2574-2167

Abstract

Abstract: Objectives: Aims of the present study were to establish generalizable outcome data on long-term functional outcomes and health-related quality of life (HRQoL) after operative treatment of pilon fractures on a large scale. Second, it was aimed to examine factors associated with these outcomes. Design: Retrospective cohort study with follow-up by questionnaire. Setting: Two level 1 trauma centers. Patients: Two hundred twenty-five of 480 eligible patients completed the survey (response rate 47%). Intervention: Open reduction internal fixation for tibial pilon fracture. Main outcome measurements: 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. Results: 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). HRQoL was significantly lower compared to a reference population ( P < .001). In multivariable regression analyses, smoking was associated with poorer HRQoL. Higher body mass index, deep infection, and lower HRQoL were associated with worse ankle function. Conclusions: Long-term patient-reported outcomes after operative treatment of pilon fractures reveal impaired functionality and lower HRQoL compared to an uninjured reference population. 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. 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. Level of evidence: Prognostic level III. Abstract : Supplemental Digital Content is available in the text