Prognostic factors of operatively treated Pilon fractures

Abstract

Objective To investigate the prognostic factors influencing the clinical outcome of Pilon fracture. Methods A retrospective cohort study of Pilon fractures treated by open reduction and internal fixation from March 2009 to November 2013 was conducted. A total of 100 patients who were followed-up more than 1 year were included in the study, including 84 males and 16 females. The average age was 42.1 years (range, 14-75 years). According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, the patients were divided into excellent clinical outcome group and non-excellent clinical outcome group. Patient-related factors (gender, age, diabetes, smoking, injury mechanism and associated injuries), fracture-related factors (fracture classification, open fracture, fibular fracture) and postoperative factors (quality of fracture reduction, return- to- work interval and complications) were evaluated. Results 34 cases including 30 males and 4 females had excellent clinical outcome with an average age of 37.3 years (range, 14-62 years). 66 cases including 54 males and 12 females had non-excellent clinical results with an average age of 44.6 years (range, 17-75 years). Univariate analysis showed that gender (P=0.567), diabetes (P= 0.296), smoking (P=0.807), injury mechanism (P=0.964), associated injuries (P=0.387) and complication (P=0.466) had no significant differences. There was a significant difference between the two groups including the age (P=0.017), fracture classification (P= 0.007), open fracture (P=0.017), fibular fracture (P=0.004), quality of fracture reduction (P< 0.001) and return-to-work interval (P=0.002). Univariate analysis showed that patients with shorter return-to-work interval and younger age had significant better clinical outcome. The ratio of high energy injury, open fractures, fibular fracture and non-optimal quality of reduction were significant higher in the non-excellent clinical outcome group. The multivariate analysis suggested that quality of the fracture reduction was an independent favorable prognostic factor. Conclusion The quality of fracture reduction was an independent favorable prognostic factor for the Pilon fracture patients which makes an excellent clinical outcome; the gender, fracture classification, open fracture, fibular fracture, return-to-work interval may also have influence on the outcome. Key words: Tibial fractures; Treatment outcome; Root cause analysis