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Five-Year Clinical Outcomes of Surgically Treated Different Types of Tibial Pilon Fractures
Timo Lenkkeri1, Ville Bister1,2, Mika Koivikko3
1Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Background:
Intra-articular distal tibial pilon fractures are most commonly caused by high-energy trauma and are often associated with severe soft-tissue injuries. The literature on medium-to-long-term clinical outcomes is limited. The purpose of this follow-up study was to evaluate the 5-year clinical outcomes and patient satisfaction among patients with different types of tibial pilon fractures.
Methods:
One hundred twenty-six consecutive patients with operatively treated tibial pilon fractures were identified between 2012 and 2016 from a level 1 trauma center. A total of 105 patients (mean age 43 years, 30 females, 100% White, 100% European) were eligible for follow-up and were contacted 5 years after the initial trauma. Outcomes were assessed using a questionnaire, Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) score, functional tests, and posttraumatic osteoarthritis (OA) Kellgren-Lawrence (K-L) grade. For outcome analysis, patients were categorized into the following 3 groups according to AO-OTA fracture classification: type 43B2-B3 (Group 1), type 43C1-C2 (Group 2), and type 43C3 (Group 3) tibial pilon fractures.
Results:
No statistically significant differences between study groups were observed in FAOS (mean 74, standard deviation [SD] 16.9) and AOFAS (mean 82, SD 12.7) scores. Posttraumatic OA (K-L grade 3-4) was diagnosed in 35% in Group 1, 8% in Group 2, and 48% in Group 3. Ten patients (8%) underwent ankle arthrodesis. The incidence of deep surgical-site infections increased with severity of fracture type (no patients in Group 1, 21% in Group 2, and 23% in Group 3). Two patients (1.6%) required below-the-knee amputation. Approximately 90% of the healthcare resources were needed within the first 2 years after injury; patients in Group 3 required the most surgeries and had the longest hospitalization.
Conclusions:
Surgically treated pilon fractures seem to result in good mid-term clinical outcomes, even for severe C3 fractures. However, type C3 fractures had more complications and required more surgical interventions, including ankle arthrodeses, longer hospitalization, and additional other healthcare resources than the less severe fractures.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
