Poor Outcomes After Anterior Impaction Pilon Fractures

Abstract

Introduction: Pilon fractures occur through high-energy axial-loading trauma and are frequently associated with complications. The goal of this study was to assess whether anterior impaction (AI) tibial pilon fractures are associated with increased rates of posttraumatic osteoarthritis (PTOA), secondary surgeries, and lower patient-reported outcomes compared with patients with non-AI pilon fractures. Methods: In this retrospective cohort study, 52 pilon fractures in 50 patients were included. The average follow-up was 25 months (range, 12 to 62 in non-AI and 12 to 66 in AI). The Kellgren and Lawrence (KL) score for PTOA, tibiotalar ratio for anterior-posterior talar subluxation, coronal tibiotalar angle, Patient-Reported Outcomes Measurement Information System score, and rates of secondary surgeries and infection were assessed. Results: The AI group showed radiographic evidence of more advanced PTOA at the final follow-up (KL score 3.1 vs. 2.5, P = 0.021) and a higher rate of implant removal for pain (39% vs. 13%, P = 0.030). AI also had greater anterior talar subluxation on preoperative (P , 0.001) and final follow-up radiographs (P = 0.026). A higher KL score was associated with greater anterior talar displacement on preoperative (r = 20.421, P = 0.003) and final follow-up radiographs (r = 20.359, P , 0.009). No differences were seen in 1-year Patient-Reported Outcomes Measurement Information System scores. Discussion: AI pilon fractures are associated with recurrent anterior talar subluxation, more severe PTOA, and a higher rate of implant removal for pain compared with non-AI fractures. Pilon fractures comprise approximately 3 to 7% of tibial fractures and less than 1% of all lower extremity fractures. [1][2][3] These fractures occur through high-energy axial-loading trauma, such as motor vehicle crashes and falls that lead to impaction of the distal tibial articular surface and disruption of the soft-tissue envelope. Given these injury characteristics, patients with pilon fractures are at a high risk of developing posttraumatic osteoarthritis (PTOA), nonunion, malunion, soft-tissue infection, and

Zugänge zum oberen Sprunggelenk

“…Die Ergebnisse mit dem anterolateralen Zugang sind abhängig von Schweregrad der Fraktur, dem Vorliegen einer anterioren Impression der Gelenkfläche und der korrekten Stabilisierung der Syndesmose [16]. Der Zugang selbst führt kaum zu Wundheilungsstörungen und führt auch zu keinen funktionellen Beeinträchtigungen [17].…”

What’s New in Foot and Ankle Surgery

“…Anterior impaction of the tibial plafond has been shown to portend a particularly poor prognosis. Jo et al 26 retrospectively reviewed 50 patients (52 fractures) who underwent open reduction and internal fixation (ORIF) of OTA/AO 43B and C pilon fractures. At a mean follow-up of 25 months, the group with anterior impaction (28 fractures) had significantly higher rates of implant removal for pain, significantly greater anterior subluxation, and significantly worse posttraumatic arthritis than the group without anterior impaction.…”

Management of High-Energy Tibial Pilon Fractures

“…Tibial pilon fractures were originally classified into 3 types by R üedi and Allg öwer 35 , but the more recently developed OTA/AO classification system 36,37 remains the most widely utilized. Some partial articular (type-43B) pilon fractures are possible in a high-energy setting, and anterior impaction can portend poorer outcomes 38,39 . However, the majority of highenergy injuries constitute type-43C (complete articular) patterns 3 .…”