The Prevalence of Subtalar Arthritis Following Pilon Fractures

Area of Science:

• Orthopedic Surgery
• Radiology
• Trauma Care

Background:

• Pilon fractures frequently lead to ankle arthritis and significant morbidity.
• Subtalar arthritis prevalence post-pilon fracture is understudied.
• Tibiotalocalcaneal (TTC) arthrodesis is increasingly used for complex pilon fractures involving the subtalar joint.

Purpose of the Study:

• To determine the prevalence and severity of post-traumatic subtalar arthritis following pilon fractures.
• To evaluate the association between patient-specific factors and subtalar arthritis development.
• To understand the implications of surgical techniques like TTC arthrodesis.

Main Methods:

• Retrospective review of 473 patients with pilon fractures treated with open reduction and internal fixation.
• Radiographic evaluation using Kellgren-Lawrence (K-L) and NSS grading systems.
• Postoperative CT scans assessed with the CT Ankle Osteoarthritis (CTAO) system.
• Statistical analysis including Pearson correlation, chi-square, Mann-Whitney U, and Welch t tests.

Main Results:

• Patient age, smoking status, steroid use, Charlson Comorbidity Index (CCI), AO/OTA classification, and time from injury correlated significantly with K-L grade.
• Longer time intervals from injury to imaging were associated with higher K-L grades.
• CTAO scores showed a correlation between subtalar arthritis and age at injury and final CT.

Conclusions:

• Patient factors and time since injury are significantly associated with subtalar arthritis after pilon fractures.
• These findings suggest that acute hindfoot nailing for pilon fractures may have fewer clinical consequences than anticipated.
• Further research is needed to fully elucidate the long-term outcomes of TTC arthrodesis in these cases.