Recovery Curve for Patients With Pilon Fractures Using Patient-Reported Outcome Measurement Information System

Kellam, Patrick; Cutshall, Zachary; DeKeyser, Graham J.; Rothberg, David L.; Higgins, Thomas F.; Haller, Justin M.; Marchand, Lucas S.

doi:10.1177/10711007231156424

Cited by 3 publications

(1 citation statement)

References 26 publications

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“…Although clinically relevant differences in the postinjury functional score between patients with and without infection were detected at the 6-month time point, the longitudinal time course remains unclear. Prior research has demonstrated a functional recovery plateau occurring anywhere from 6 months to 5 years after the original injury, and so it should be assumed that patients in this cohort are continuing to improve beyond 6 months 44-47 . Second, it was possible that, over a longer time course, patients who develop an infection catch up, particularly because many patients remain under active treatment near to or during this 6-month time point.…”

Section: Discussionmentioning

confidence: 99%

Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes

Gitajn,

Werth,

Carlini

et al. 2024

JBJS Open Access

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Background: Fracture-related infection is one of the most challenging complications in orthopaedic trauma surgery. However, the effect of infection on functional and pain-related outcomes has not been well established. The aims of this study were to evaluate functional recovery for patients with fracture and a deep surgical site infection compared with patients with fracture without infection and to evaluate whether pain severity, social support, and preinjury mental health have a moderating effect on the magnitude and direction of the relationship between deep surgical site infection and functional recovery. Methods: This is a secondary retrospective cohort study using prospectively collected data from the VANCO trial (Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection) and the OXYGEN (Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery) trial. In this study, 2,116 patients with tibial plateau, pilon, or calcaneal fractures at high risk for infection were included. Patients were divided into cohorts of patients who experienced a deep surgical site infection and those who did not. The primary outcome measure was the functional outcome using the Veterans RAND 12-Item Health Survey (VR-12). Results: After controlling for covariates, deep surgical site infection was independently associated with functional outcome, with a 3.3-point reduction in the VR-12 Physical Component Score, and pain severity was independently associated with functional outcome, with a 2.5-point reduction in the VR-12 Physical Component Score. Furthermore, the Brief Pain Inventory pain severity demonstrated an important moderating effect on the relationship between infection and functional outcome. In patients with lower pain scores, infection had a large negative impact on functional outcome, whereas, in patients with higher pain scores, infection had no significant impact on functional outcome. Furthermore, the functional outcome in the entire cohort remains at only 61% of baseline. Conclusions: This study documents the negative impact of postoperative infection on functional recovery after injury, as well as the novel finding of pain severity as an important moderating factor. This study emphasizes not only the importance of developing effective interventions designed to reduce postoperative infection, but also the role that factors that moderate pain severity plays in limiting recovery of physical function. Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes

Gitajn,

Werth,

Carlini

et al. 2024

JBJS Open Access

View full text Add to dashboard Cite

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Early posterior column internal fixation: A staged treatment of type C3 tibial pilon fracture

Gao,

Peng,

Wang

et al. 2024

Injury

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Recovery Curves for Lisfranc ORIF Using PROMIS Physical Function and Pain Interference

Dong,

Sroka,

Campbell

et al. 2024

Journal of Orthopaedic Trauma

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Objective: To determine the postoperative trajectory and recovery of patients who undergo Lisfranc ORIF using PROMIS physical function (PF) and pain interference (PI). Methods: Design: Retrospective cohort study Setting: Level 1 trauma center Patient Selection Criteria: Patients who underwent Lisfranc ORIF between January 2002 and December 2022 with documented PROMIS PF and/or PI scores after surgery. Outcome Measures and Comparisons: PROMIS PF and PI were mapped over time up to 1 year after surgery. A sub-analysis was performed to compare recovery trajectories between high and low energy injuries. Results: A total of 182 patients were included with average age of 38.7 (SD 15.9) years (59 high energy and 122 low energy injuries). PROMIS PF scores at 0-weeks, 6-weeks, 12-weeks, 24-weeks, and 48-weeks were 30.2, 31.4, 39.2, 43.9, and 46.7, respectively. There was significant improvement in PROMIS PF between 6-12 weeks (p<0.001), 12-24 weeks (p<0.001), and 24-48 weeks (p=0.022). A significant difference in PROMIS PF between high and low energy injuries was seen at 0-weeks (28.4 vs.31.4, p=0.010). PROMIS PI scores, at 0-weeks, 6-weeks, 12-weeks, 24-weeks, and 48-weeks were 62.2, 58.5, 56.6, 55.7, and 55.6, respectively. There was significant improvement in PROMIS PI 0-6 weeks (p=0.016). A significant difference in PROMIS PI between high and low energy injuries was seen at 48-weeks with scores of (58.6 vs. 54.2, p=0.044). Conclusions: After Lisfranc ORIF, patients can expect improvement in physical function up to one year after surgery, with the biggest improvement in PROMIS physical function scores between 6-12 weeks and PROMIS pain interference scores between 0-6 weeks after surgery. Regardless energy type, Lisfranc injuries seem to regain comparable physical function by 6-12 months after surgery. However, patients with higher energy Lisfranc injuries should be counseled that these injuries may lead to worse pain interference at one year after surgery as compared to lower energy injuries. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Recovery Curve for Patients With Pilon Fractures Using Patient-Reported Outcome Measurement Information System

Cited by 3 publications

References 26 publications

Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes

Deep Surgical Site Infection after Fracture Has a Profound Effect on Functional Outcomes

Early posterior column internal fixation: A staged treatment of type C3 tibial pilon fracture

Recovery Curves for Lisfranc ORIF Using PROMIS Physical Function and Pain Interference

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