Long-Term Trajectory of Recovery Following Pilon Fracture Fixation

Objectives To describe the trajectory of recovery following fixation of pilon fractures from baseline to 5 years follow-up. Design Prospective cohort study. Setting Level 1 trauma centre. Patients/participants Patients with pilon fractures (OTA/AO 43.C) treated with open reduction and internal fixation (ORIF). Intervention None. Main outcomes measurements Patient reported outcome measures (PROMs) were measured at baseline, 6 months, 1 year and 5 years using the Short-Form 36 Health Survey Physical and Mental Component Scores (SF-36; PCS, MCS), Short Musculoskeletal Functional Assessment (SMFA), and the Foot and Ankle Outcome Score (FAOS). Results 102 patients were enrolled: mean age was 42.6 years; 69% were males; 88% had an injury severity score (ISS) of 9; 74 patients (73%) completed 1 year follow-up; 40 patients (39%) completed 5 years follow-up. Trajectory of recovery of physical function showed a significant decline between baseline and 6 months, with significant improvement between 6 months and 1 year, and then ongoing but slower improvement between 1 year and 5 years. 64% of patients returned to baseline SF-36 PCS at 5 years. Pain was a persistent issue and remained significantly worse at 5 years when compared to baseline. Psychological wellbeing (SF-36 MCS) did not significantly change from baseline at 5 years. Conclusion Functional recovery following ORIF for pilon fractures was characterized by an initial decrease in function from baseline, followed by an increase between 6 months and 1 year, and then slower but continued increases from 1 year to 5 years. Function did not return to baseline levels, pain was a persistent issue, and mental wellbeing showed no change from baseline at 5 years. This information may be useful when counselling patients.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.