Patient-reported outcome measures after tibial pilon fractures: A systematic review

There is no consensus on optimal patient-reported outcome measures (PROMs) for pilon fractures. Current ankle trauma scoring systems focus mainly on pain, which accounts for 80 % of score variability. This review aims to assess widely used PROMs for pilon fractures and report their reliability and validity.

A systematic search of PubMed, SCOPUS, and Web of Science was conducted. Studies were included if they involved at least 10 patients with AO-OTA 43 C fractures, assessed at least one PROM, and had a minimum one-year follow-up. Studies were screened using Rayyan, utilizing author consensus.

87 studies (3828 patients) were included. Of the 26 total PROMs tools utilized, the AOFAS Hindfoot-Ankle Score was the most used PROM (57 %), with pain assessed in 75 % of cases. Mental health was considered in only 23 %, and no PROMs were specifically validated for pilon fractures. Three studies (3.4 %) explicitly validated or assessed the reliability of the PROMs utilized.

The review highlights the heterogeneity in PROM selection for pilon fractures and insufficient reliability and validity measurements, emphasizing the need for standardized, pilon fracture-specific PROMs to better evaluate outcomes. The results of this study can guide future consensus statements on developing a standardized set of PROMs for pilon fractures to improve evaluation of patient outcomes.

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