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Outcomes After Treatment of High-Energy Tibial Plafond Fractures

Investigation performed at the University of Maryland School of Medicine and the R Adams Cowley Shock Trauma Center, Baltimore, Maryland, and the University of Washington School of Medicine and Harborview Medical Center, Seattle, Washington

Andrew N. Pollak, MD
Department of Orthopaedics, University of Maryland School of Medicine, 22 South Greene Street, Suite T3R54, Baltimore, MD 21201. E-mail address: apollak{at}umoa.umm.edu

Melissa L. McCarthy, MS, ScD
Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-111, Baltimore, MD 21205

R. Shay Bess, MD
Department of Orthopaedics, University of Cleveland School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106

Julie Agel, ATC
Marc F. Swiontkowski, MD
Department of Orthopaedics, University of Minneapolis School of Medicine, 2450 Riverside Avenue, South, Minneapolis, MN 55455

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from AO International Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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. Our purpose was to assess midterm health, function, and impairment after pilon fractures and to examine patient, injury, and treatment characteristics that influence outcome.

Methods: A retrospective cohort analysis of pilon fractures treated at two centers between 1994 and 1995 was conducted. Patient, injury, and treatment characteristics were recorded from patient interviews and medical record abstraction. Study participants returned to the initial treatment centers for a comprehensive evaluation of their health status. The primary outcomes that were measured included general health, walking ability, limitation of range of motion, pain, and stair-climbing ability. A secondary outcome measure was employment status.

Results: Eighty (78%) of 103 eligible patients were evaluated at a mean of 3.2 years after injury. General health, as measured with the Short Form-36 (SF-36), was significantly poorer than age and gender-matched norms. Thirty-five percent of the patients reported substantial ankle stiffness; 29%, persistent swelling; and 33%, ongoing pain. Of sixty-five participants who had been employed before the injury, twenty-eight (43%) were not employed at the time of follow-up; nineteen (68%) of the twenty-eight reported that the pilon fracture prevented them from working. Multivariate analyses revealed that presence of two or more comorbidities, being married, having an annual personal income of less than $25,000, not having attained a high-school diploma, and having been treated with external fixation with or without limited internal fixation were significantly related to poorer results as reflected by at least two of the five primary outcome measures.

Conclusions: At more than three years after the injury, pilon fractures can have persistent and devastating consequences on patients' health and well-being. Certain social, demographic, and treatment variables seem to contribute to these poor outcomes.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

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Outcomes After Treatment of High-Energy Tibial Plafond Fractures • A.N. Pollak, M.L. McCarthy, M.F. Swiontkowski, and J. Agel reply

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