Poor Outcomes After Anterior Impaction Pilon Fractures

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Radiology

Background:

• Pilon fractures result from high-energy axial loading and often lead to complications.
• Anterior impaction (AI) is a specific type of pilon fracture that may have unique outcomes.

Purpose of the Study:

• To compare anterior impaction (AI) tibial pilon fractures with non-AI fractures regarding posttraumatic osteoarthritis (PTOA), secondary surgeries, and patient outcomes.

Main Methods:

• Retrospective cohort study of 52 pilon fractures in 50 patients.
• Assessment of Kellgren and Lawrence (KL) score for PTOA, tibiotalar ratio for talar subluxation, coronal tibiotalar angle, and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.
• Evaluation of secondary surgery and infection rates.

Main Results:

• AI fractures showed significantly more advanced PTOA (KL score 3.1 vs. 2.5, P=0.021) and greater anterior talar subluxation preoperatively and at final follow-up.
• The AI group had a higher rate of implant removal due to pain (39% vs. 13%, P=0.030).
• Higher KL scores correlated with greater anterior talar displacement.

Conclusions:

• Anterior impaction (AI) pilon fractures are linked to recurrent anterior talar subluxation and more severe PTOA.
• AI fractures are associated with a higher incidence of implant removal for pain compared to non-AI fractures.