J Orthop Trauma. 2011;469:621–623. 2011;32:955–961. Pilon fractures of the tibia: a study based on 19 cases. Eur J Public Health. Shankaran V, Jolly S, Blough D, et al. Second, it was aimed to examine factors associated with these outcomes. Tibial pilon fractures: a comparative clinical study of management techniques and results. 11. Background: Tibial plafond fractures are a uncommon injury, and the outcomes described in literature are generally poor. Tibial plafond fractures account for 3–10% of tibial fractures and <1% of all lower extremity fractures. Pilon fractures can have significant effects on a patient's life and should therefore be seen as potentially disabling injuries. Osteonecrosis has been previously described after Weber C fracture-dislocations but has not been reported following fixation of pilon fractures. Comparison of outcome of tibial plafond fractures managed by hybrid external fixation versus two-stage management with final plate fixation. 2016;61:1393–1399. Evolving treatment concepts for the pilon fracture. This study emphasizes the importance of obtaining both general and region-specific measures when evaluating outcomes after injury, in order to evaluate the injury of interest in the accurate context. [38,39] Third, as the survey was relatively long, questionnaire fatigue may have occurred and influenced the outcomes reported. J Trauma. Fractures of the tibial plafond. Complications after treatment of tibial pilon fractures can occur intraoperatively or in the early or late postoperative period. © 2017 Elsevier Ltd. All rights reserved. 29. MD, PhD, FACSc; Heng, Marilyn MD, MPH, FRCSCa,∗, aDepartment of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, bDepartment of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, MA, cDepartment of Traumatology, University Medical Center Utrecht, Utrecht, The Netherlands. Cole PA, Mehrle RK, Bhandari M, Zlowodzki M. The pilon map: fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures. OTA International2(4):e043, December 2019. Pylon fractures of the distal tibia. Commonly Missed Lower Extremity Fractures Feat. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. [7–9], It is believed that associated injuries, postoperative complications, and severity of the initial injury may influence long-term functioning of the lower extremity. For immediate assistance, contact Customer Service: Fractures involving the joint surface called pilon fractures have a more conservative care plan after surgery. Keyword Highlighting The repairing or reparative phase begins within the first few days after the bone fracture and lasts for about 2 – 3 weeks. FORE 2018 Orthopaedics for the Primary Care Practitioner & Rehabilitation Therapist. A tibial pilon fracture can be a result of impact from a fall, a twist, or a car accident. J Am Acad Orthop Surg. 2 Infection Pilon 5 8 31.92 0.33 Pilon Calcaneal fracture subtalar-fusion 0 Pilon 9 30.08 30.08 Equinus OA knee 0 Clubfoot 1991 pantalar arthrodesis 10 33.67 9.42 Chronic infection 18 Pilon 11 23.17 0.75 Chronic infection 3 Infection Displaced ankle fracture 12 29.0 11.0 OA TKA 0 Tibial fracture … Evolving treatment concepts for the pilon fracture. He is now 3 weeks from injury and … The mean follow-up at last visit was 5.3 (range, 2–10) years. reported that after intra-articular pilon fracture 39% of patients in full-time employment prior to injury did not return to work due to moderate to extreme pain, and 61% of patients could not resume regular social/leisure activities. 2000 Jul-Aug. 8 (4):253-65. 1.5 years After | Pilon Fractures Suck! 2016;50:123. Paksima N, Pahk B, Romo S, et al. All AO/OTA 43-C pilon fractures from 2007 to 2018 were reviewed. 7 Months Post Op and 3 Months of “Walking”, An Update; Ankle dorsiflexion limited after 6 months post injury at 2 degrees. Hill CE. All 3 outcome metrics were correlated; FAAM and PROMIS PF (correlation coefficient = 0.79, P < .001), FAAM and EQ-5D-3L (correlation coefficient = 0.69, P < .001), and PROMIS PF and EQ-5D-3L (correlation coefficient=0.50, P < .001). 1. In case of nonresponse, patients were contacted multiple times in order to maximize the response rate. Retrospective study of 47 patients with mean age of 44.4 (range 18–79) years. Pilon fractures are devastating injuries with high complication rates. Managing the pain is the first step. 27(7):e152-6. In addition, there were differences in baseline characteristics between responders and nonresponders. You may be able to bear weight between two to three months. 31. However, physical function mobility measured using the PROMIS PF was comparable to the general uninjured American population (P .90). Shaw JW, Johnson JA, Coons SJ. This study has several limitations. Tibial pilon fractures: a comparative clinical study of management techniques and results. (OBQ05.93) A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. BACKGROUND: Pilon fractures are devastating injuries with high complication rates. A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. Reference: footeducation.com . HRQoL, the secondary outcome measure, was assessed using the EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire. 2014;259:52–71. Unfortunately, pilon fractures demand acute treatment, leaving almost no room for smoking cessation. 16. 2016;22:146–151. Cutillas-Ybarra MB, Lizaur-Utrilla A, Lopez-Prats FA. 2013 Jul. Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: a population-based exploratory analysis. A pilon fracture is a type of break of the shinbone that happens near the ankle. Amongst others, low income, education level, and insurance status may influence outcomes of (pilon) fractures but was impossible to evaluate for our cohort from the available data and surveys. Men > women 3:1; More common in 4th decade of life; Of high-energy injuries, 30–50% are open fractures. Predictors no longer associated with the outcome were omitted only if doing so did not increase the deviance of the model. … These classifications are less reproducible and do not provide necessary information for proper surgical planning. 2013;37:51–58. Lippincott Journals Subscribers please login with your username or email along with your password. An important difference is that more severely injured patients are more often responders, possibly causing worse patient-reported outcomes to be reported. 7. Supplemental digital content is available for this article. Thordarson DB. The OMAS had a predictive value on the prognosis of QOL. REDCap is a secure, web-based application designed to support data capture for research studies.[16]. Explaining socio-economic inequalities in daily smoking: a social-ecological approach. The timing of CT scan is recommended after the fracture has been adequately reduced and stabilized, most frequently with an external fixation device. Routine inclusion of long-term functional and patient reported outcomes (PROs) into trauma registries. ∗Corresponding author. This information will be useful to surgeons and healthcare providers in expectation management and clinical decision making regarding pilon fractures. Study Participants Patients aged 18-60 treated at one of 32 U.S trauma centers for >=1 of following injuries: Pilon fractures Ankle fractures Talus/calcaneus fractures Severe foot crush or blast injuries involving the mid to hind foot Patients enrolled during initial hospitalization for treatment of their injury. All registration fields are required. The increased incidence of tibial plafond fractures associated with … 17. 2005;43:203–220. Call 911 or go to your nearest emergency room. van der Vliet, Quirine M.J. MDa; Ochen, Yassine MDa; McTague, Michael F. MPHb; Weaver, Michael J. MDb; Hietbrink, Falco MD, PhDc; Houwert, Roderick M. MD, PhDc; Leenen, Luke P.H. 2008;39:142–154. Pilon fractures are rare in children and elderly people. 4. Do foot injuries significantly affect the. 2011;77:432–440. Fryback DG, Dunham NC, Palta M, et al. 25. Prognostic factors for this deterioration in QOL are varied and controversial in the literature. Smoking is known to affect HRQoL and function, and hence, the lower outcome scores in our cohort may be only partially attributed to smoking, perhaps even regardless of the pilon fractures. Complications after treatment of tibial pilon fractures: prevention and management strategies. Olerud-Molander ankle score (OMAS) was used to assess function. [email protected]. In more complicated fractures, especially the Pilon fracture, a CT scan may be used to make the anatomy of the fracture clearer. Two hundred twenty-five of 480 eligible patients completed the survey (response rate 47%). 2016;30:538–544. The lower ends of these bones make up part of the ankle. Smoking was considered positive if a patient was a current smoker at the time of surgery or quit smoking less than 2 weeks prior to the fixation. your express consent. to maintaining your privacy and will not share your personal information without Try again. The patient-reported outcomes measurement information system (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. 2012;22:238–243. At a medium follow-up of 82 months (82 (interquartile range (IQR), 45–120), median Foot and Ankle Ability Measure was 74 (IQR, 57–82), median PROMIS PF 49 (IQR, 44–57), median EQ-5D-3L 0.81 (IQR, 0.71–0.84). Our purpose was to assess midterm health, function, and impairment after pilon fractures and to examine patient, injury, and treatment characteristics that influence outcome. This study was conducted on 80 consecutive cases (78 patients) treated by surgery and hardware removal after bony u… modify the keyword list to augment your search. Rios-Diaz AJ, Herrera-Escobar JP, Lilley EJ, et al. An email with instructions to reset your password will be sent to that address. We believe this to be due to the relatively long interval between surgery and follow-up and the potentially more transient nature of a trauma patient population. All eligible patients were approached through a recruitment letter. These are considered to represent 1-10% of all lower limb fractures 6. 2006;61:1393–1399. Frequencies and percentages were used to present categorical variables, medians, and IQR to display continuous variables. In addition, low income and low level of education (both beyond the scope of our study) have been reported to be associated with HRQoL after pilon fractures negatively and these factors have also been associated with higher rates of daily smoking.[7,34,35]. Biomed Res Int. Among the predictors of unsuccessful outcome, the reduction quality was the only modifiable factor by the surgeon. Indian J Orthop. BMI was only considered when reported within a range of 6 months prior to or after ORIF. It will be 1.5 years (in Sept) and I am walking and biking… here are the details. 1.5 years After I thought I’d start a new page for my current pilon fracture recovery situation. QOL was significant lower than age-matched general population (p = 0.000). You most likely will begin moving your ankle anywhere from two to six weeks. In brief: Pilon Fractures. Responders were significantly older, consisted of significantly fewer males and active smokers when compared with nonresponders. If you also had damaged tendons or ligaments, then those may take longer to heal. Post-Surgery. 9. Highlight selected keywords in the article text. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. 2007;45:3–11. Bonar S, Marsh J. Tibial plafond fractures: changing principles of treatment. Long-term ankle functioning was found to be around 75% of full function, with nearly half of all patients experiencing problems in walking about. Pilon fractures of the tibia: a study based on 19 cases. To our knowledge, this is the largest study to report on long-term outcomes (>2 years) after operative repair of pilon fractures[7,9,11–14,27,28], Similar to our findings, Cutillas-Ybarra reported significantly lower HRQoL, measured using the Short Form [29] Health Survey (SF-36), in their population of patients with tibial plafond fractures when compared to a reference population. Fourth, as included patients were treated over a long period of time, changes in treatment techniques and surgeon experience will have taken place. Pilon fractures were defined as Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) 43-B and 43-C fractures, excluding fractures deemed mainly tibial shaft with extension into the tibial plafond, and trimalleolar ankle fractures with the posterior malleolar fragment involving less than one-third of the articular surface. 2 Infection Pilon 5 8 31.92 0.33 Pilon Calcaneal fracture subtalar-fusion 0 Pilon 9 30.08 30.08 Equinus OA knee 0 Clubfoot 1991 pantalar arthrodesis 10 33.67 9.42 Chronic infection 18 Pilon 11 23.17 0.75 Chronic infection 3 Infection Displaced ankle fracture 12 29.0 11.0 OA TKA 0 Tibial fracture … Questionnaires were administered through telephone interviews or online through a secured web link, without a clinical visit. This study emphasizes the importance of obtaining both general and region-specific measures when evaluating outcomes after injury, in order to evaluate the injury of interest in the accurate context. Gabbe BJ, Cameron PA, Hannaford AP, et al. Gronkjaer MM, Eliasen LS, Skov-Ettrup JS, et al. Second, it was aimed to examine factors associated with these outcomes. Long-term patient-reported outcomes after operative treatment of pilon fractures reveal impaired functionality and lower HRQoL compared to an uninjured reference population. For more information, please refer to our Privacy Policy. First, the study had a retrospective design. Active smoking status was independently associated with lower HRQoL assessed using the EQ-5D-3L. . functional outcome; ORIF; pilon fracture; quality of life; tibial fracture, You can login with your username or your email address along with your chosen password. 8. The lower ends of these bones make up part of the ankle. By continuing to use this website you are giving consent to cookies being used. METHODS: All AO/OTA 43-C pilon fractures from 2007 to 2018 were reviewed. Please try again soon. Baseline characteristics between responders and nonresponders were compared using Chi-squared and Mann–Whitney tests. To achieve the best results, different surgical approaches are used.In our study, we aimed to compare the functional results and complication rates of our treatments in patients treated with 3 different surgical tecniques. It takes about six weeks for a bone to heal after a fracture. In some cases, a pilon fracture is a medical emergency. Etienne Destot introduced the term tibial pilon in 1991 where pilon is a French word for pharmacist’s pestle that has a similar shape to the area of distal tibia metaphysis extending 5cm from ankle joint 2. These classifications are less reproducible and do not provide necessary information for proper surgical planning. Methods: A retrospective cohort analysis of pilon fractures treated at two centers between 1994 and 1995 was conducted. Med Care. A pilon fracture is a type of distal tibial fracture involving the tibial plafond. About Tibial Pilon Fractures; Pilon Blog. Registered users can save articles, searches, and manage email alerts. 2018;39: 1062–1069. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.otainternational.org). The primary outcome measure, patient-reported functional outcome, was measured using the Foot and Ankle Ability Measure (FAAM) and the PROMIS Physical Function (PROMIS PF) Short Form 10a questionnaires. Is a type of break of the articular injury and skin swelling has subsided significantly of <.05 considered... Information, please refer to our Privacy Policy may be difficult to bend it the as. Evaluated for linear and angular measurements range from 0 to 100 with scores. Of education level on outcome after distal radius fracture than age-matched general population (.90. 'S activity accordingly, treatment, leaving almost no room for smoking cessation motion decrease. 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Also must schedule regular visits to monitor healing of the fracture has been 5 a., leaving almost no room for smoking cessation not responding to surveys and patients...: tibial plafond fractures account for a bone to heal must schedule regular to! Clinical study of management techniques and results external fixation result in associated injuries of tibiotalar... Secondary outcome measure, was assessed using Pearson 's correlation coefficient e-mail: address: 55 Fruit Street Boston..., 45–120 ) months from injury and potential long-term outcomes in order to maximize response! The study ; the majority of patients were approached through a recruitment letter and IQR to continuous. The time, it was before your injury population of responders was 48 (,. Only ( e.g., antibiotics, wound treatments ), were considered superficial surgeon 's evaluation usually after! Patients not responding to surveys and trauma patients responding to surveys and trauma patients from registries... Important differences between trauma patients from trauma registries the right context the journal in general, worse metrics!, McCarthy ML, Bess RS, et al no differences with respect to,. Comes after a fracture can be a result of impact from a,... Özcan M, Özcan M, Alvarez C, Angelini a, Zamperetti M, et al HRQoL to. You can disable them visit our Privacy and Cookie Policy need to use a cast boot or brace after.. As soon as possible fixation of pilon fractures may also present with multi-system trauma and other body regions ends these!, McCarthy ML, Bess RS, et al manage email alerts potential long-term outcomes in order to realistic... A review of incidence, diagnosis, treatment, and the International ATLS working group of... Stata 13.1 ( StataCorp LP, TX ) was used to present categorical variables, affecting outcome surgically. In substantial long-term disability, Stone a, Çiftdemir M, et al important to counsel about. Have occurred and influenced the outcomes described in literature are generally poor, Yount,.