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The sequential recovery of health status after tibial plafond fractures
J Lawrence Marsh1, Todd McKinley, Douglas Dirschl
1Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. j-marsh@uiowa.edu
Objectives:
To assess the recovery of ankle function and general health status at multiple time points during the first 24 months after an isolated tibial plafond fracture treated with joint-spanning external fixation and to determine factors that affect a rapid versus a slow recovery and factors that influence patient outcome at a minimum of 2 years after injury.
Design:
Prospective observational study.
Setting:
Two Level I trauma centers.
Patients:
Forty-three patients (mean age, 42 years; range, 20-60 years) with unilateral fractures of the tibial plafond were prospectively assessed. These 43 patients had a 24 month follow up and were seen for at least three additional scheduled visits before the 24-month follow up.
Intervention:
Spanning articulated external fixator and follow ups at defined time intervals after injury to track the progress of the outcome measures over time.
Main Outcome Measures:
The Short Form Health Survey (SF-36) Medical Outcomes Study (MOS) version 2 Physical Component Summary Score (PCS) and Mental Component Summary Score (MCS) and the Ankle Osteoarthritis (AOS) Pain and Disability Scales.
Results:
Early after injury, the MCS was not as negatively affected as the PCS. By 6 months after injury, the MCS had improved to be equivalent to age-matched norms and remained there at 2 years after injury. The PCS was more severely compromised and did not level off until the 12-month clinic visit. At 2 years, the PCS remained on average one standard deviation below age-matched normal. Although not statistically significant, both the average pain and disability AOS scales deteriorated between 6 and 12 months, suggesting some patients actually perceived their ankle as being worse as they begin walking on their injured ankle. Between 12 and 24 months, they trended toward improvement in both the pain and function scales. However, their ankle continued to have dramatically increased pain and decreased function compared with population-based norms.
Conclusions:
In patients recovering from a tibial plafond fracture that was treated with joint-spanning external fixation, the MCS improves quickly and completely, whereas the PCS often takes 1 full year or longer to reach maximal improvement and does not completely recover, because it remains on average one standard deviation below normal at 2 years after injury. Changes in the AOS pain and disability scales between 6 and 12 months after injury were not significantly different but at all time points, the patient's ankle pain and function remains dramatically different than the normal population. These results can be used in future studies for comparison with patients treated with alternate treatment techniques and to assess the effect of important treatment variables such as stabilization techniques and quality of reduction.
