Pollak, J Bone Joint Surg Am 2003 - Outcomes after Treatment of High-Energy Tibial Plafond Fractures

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Outcomes after Treatment of High-Energy Tibial Plafond Fractures

Pollak, Swiontkowski, et al.·J Bone Joint Surg Am·2003·298 citations·Retrospective cohort

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Background

Although a number of investigators have documented clinical outcomes and complications associated with tibial plafond, or pilon, fractures, very few have examined functional and general health outcomes associated with these fractures. Our purpose was to assess midterm health, function, and impairment after pilon fractures and to examine patient, injury, and treatment characteristics that influence outcome.

Methods

A retrospective cohort analysis of pilon fractures treated at two centers between 1994 and 1995 was conducted.
Patient, injury, and treatment characteristics were recorded from patient interviews and medical record abstraction.
Study participants returned to the initial treatment centers for a comprehensive evaluation of their health status.
The primary outcomes that were measured included general health, walking ability, limitation of range of motion, pain, and stair-climbing ability.
A secondary outcome measure was employment status.

Results

80 (78%) of 103 eligible patients were evaluated at a mean of 3.2 years after injury.
General health, as measured with the Short Form-36 (SF-36), was significantly poorer than age and gender-matched norms.
35 percent of the patients reported substantial ankle stiffness; 29%, persistent swelling; and 33%, ongoing pain.
Of 65 participants who had been employed before the injury, 28 (43%) were not employed at the time of follow-up; 19 (68%) of the 28 reported that the pilon fracture prevented them from working.
Multivariate analyses revealed that presence of 2 or more comorbidities, being married, having an annual personal income of less than $25,000, not having attained a high-school diploma, and having been treated with external fixation with or without limited internal fixation were significantly related to poorer results as reflected by at least 2 of the 5 primary outcome measures.

Conclusions

At more than three years after the injury, pilon fractures can have persistent and devastating consequences on patients' health and well-being. Certain social, demographic, and treatment variables seem to contribute to these poor outcomes.

Level of evidence: Prognostic study, Level II-1 (retrospective study). Copyright remains with the authors and publisher.

Outcomes after Treatment of High-Energy Tibial Plafond Fractures

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Paprosky, Lawrence, et al.J Arthroplasty19941,213 citationsRetrospective cohort

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Adolescent Idiopathic Scoliosis: A New Classification to Determine Extent of Spinal Arthrodesis.

Lenke, Blanke, et al.J Bone Joint Surg Am20011,720 citationsDiagnostic study

Problems in the Management of Type III (Severe) Open Fractures: A New Classification of Type III Open Fractures.

Gustilo, Williams, et al.J Trauma19842,361 citationsRetrospective cohort

Neer Award 2005: The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty.

Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

A System for the Surgical Staging of Musculoskeletal Sarcoma.

Enneking, Goodman, et al.Clin Orthop Relat Res19802,112 citationsRetrospective cohort

Fracture Fixation in the Operative Management of Hip Fractures (FAITH): An International, Multicentre, Randomised Controlled Trial.

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Fatty Muscle Degeneration in Cuff Ruptures. Pre- and Postoperative Evaluation by CT Scan.

Goutallier, Voisin, et al.Clin Orthop Relat Res19942,669 citationsProspective cohort

Dislocations after Total Hip-Replacement Arthroplasties.

Lewinnek, Zimmerman, et al.J Bone Joint Surg Am19782,549 citationsRetrospective cohort

Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis.

Walch, Khoury, et al.J Arthroplasty19991,142 citationsRetrospective cohort

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DenisSpine (Phila Pa 1976)19832,566 citationsRetrospective cohort

The Reverse Shoulder Prosthesis for Glenohumeral Arthritis Associated with Severe Rotator Cuff Deficiency. A Minimum Two-Year Follow-Up Study of Sixty Patients.

Frankle, Vasey, et al.J Bone Joint Surg Am2005773 citationsRetrospective cohort

Randomized Trial of Reamed and Unreamed Intramedullary Nailing of Tibial Shaft Fractures.

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A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.

Vaccaro, Oner, et al.Spine (Phila Pa 1976)2005866 citationsConsensus statement

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FLOW Investigators, Guyatt, et al.N Engl J Med2015347 citationsRCT

Curve Progression in Idiopathic Scoliosis.

Weinstein, PonsetiJ Bone Joint Surg Am1983641 citationsRetrospective cohort

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Burkhart, De BeerArthroscopy20001,884 citationsCase series

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Baumgaertner, Keggi, et al.J Bone Joint Surg Am19951,441 citationsRetrospective cohort

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Berndt, HartyJ Bone Joint Surg Am1959945 citationsBiomechanical study

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Weinstein, SPORT Investigators, et al.N Engl J Med20081,207 citationsRCT

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Herring, Browne, et al.J Pediatr Orthop1992461 citationsRetrospective cohort

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Yamaguchi, Middleton, et al.J Shoulder Elbow Surg2001498 citationsRetrospective cohort

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Burkhart, Jolson, et al.Arthroscopy1993469 citationsAnatomic study

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O'Driscoll, Morrey, et al.J Bone Joint Surg Am1991997 citationsCase series

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O'Sullivan, Zee, et al.Lancet20021,587 citationsRCT

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Arnoczky, WarrenAm J Sports Med19821,227 citationsAnatomic study

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MirelsClin Orthop Relat Res19891,222 citationsRetrospective cohort

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Neer, Fukuda, et al.J Bone Joint Surg Am1983774 citationsCase series

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Stiell, Worthington, et al.JAMA20011,283 citationsProspective cohort

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Gerber, Vinh, et al.J Bone Joint Surg Am1990441 citationsAnatomic study

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Snyder, Friedman, et al.Arthroscopy19901,264 citationsCase series

Displaced Proximal Humeral Fractures. II. Treatment of Three-Part and Four-Part Displacement.

NeerJ Bone Joint Surg Am19701,283 citationsRetrospective cohort

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NeerJ Bone Joint Surg Am1972536 citationsCase series

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Griffin, FASHIoN Study Group, et al.Lancet2018542 citationsRCT

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Dejour, Guier, et al.Knee Surg Sports Traumatol Arthrosc19941,987 citationsCase-control study

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Judet, Letournel, et al.J Bone Joint Surg Am1964980 citationsCase series

Inferior Capsular Shift for Involuntary Inferior and Multidirectional Instability of the Shoulder. A Preliminary Report.

Neer, FosterJ Bone Joint Surg Am1980934 citationsCase series

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Glassman, Schwab, et al.Spine (Phila Pa 1976)20051,878 citationsRetrospective cohort

An Analysis of Outcomes of Reconstruction or Amputation after Leg-Threatening Injuries.

Bosse, Castillo, et al.N Engl J Med2002901 citationsProspective cohort

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Poppen, WalkerJ Bone Joint Surg Am1976886 citationsCase-control study

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Harms, MelcherSpine (Phila Pa 1976)20011,528 citationsCase series

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Hoffman, Zucker, et al.N Engl J Med20001,302 citationsProspective cohort

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SwansonJ Hand Surg Am1976429 citationsReview article

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PipkinJ Bone Joint Surg Am1957445 citationsCase series

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Anderson, Park, et al.J Bone Joint Surg Am1975416 citationsCase series

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Herring, Browne, et al.J Bone Joint Surg Am2004143 citationsProspective cohort

The Role of the Scapula in Athletic Shoulder Function.

KiblerAm J Sports Med19981,240 citationsReview article

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Watson, BalletJ Hand Surg Am19841,138 citationsRetrospective cohort

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Valle, PaproskyJ Bone Joint Surg Am2003199 citationsRetrospective cohort

The Tibial Plateau Fracture. The Toronto Experience 1968--1975.

Schatzker, Bruce, et al.Clin Orthop Relat Res19791,029 citationsRetrospective cohort

Surgical Dislocation of the Adult Hip a Technique with Full Access to the Femoral Head and Acetabulum without the Risk of Avascular Necrosis.

Ganz, Berlemann, et al.J Bone Joint Surg Br20011,367 citationsCase series

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Hertel, Leunig, et al.J Shoulder Elbow Surg2004837 citationsProspective cohort

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Fisher, Fourney, et al.Spine (Phila Pa 1976)20101,224 citationsConsensus statement

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Outcomes after Treatment of High-Energy Tibial Plafond Fractures

Pollak, Swiontkowski, et al.·J Bone Joint Surg Am·2003·298 citations·Retrospective cohort

Free Full Text·DOI·PubMed

|

Background

Although a number of investigators have documented clinical outcomes and complications associated with tibial plafond, or pilon, fractures, very few have examined functional and general health outcomes associated with these fractures. Our purpose was to assess midterm health, function, and impairment after pilon fractures and to examine patient, injury, and treatment characteristics that influence outcome.

Methods

A retrospective cohort analysis of pilon fractures treated at two centers between 1994 and 1995 was conducted.
Patient, injury, and treatment characteristics were recorded from patient interviews and medical record abstraction.
Study participants returned to the initial treatment centers for a comprehensive evaluation of their health status.
The primary outcomes that were measured included general health, walking ability, limitation of range of motion, pain, and stair-climbing ability.
A secondary outcome measure was employment status.

Results

80 (78%) of 103 eligible patients were evaluated at a mean of 3.2 years after injury.
General health, as measured with the Short Form-36 (SF-36), was significantly poorer than age and gender-matched norms.
35 percent of the patients reported substantial ankle stiffness; 29%, persistent swelling; and 33%, ongoing pain.
Of 65 participants who had been employed before the injury, 28 (43%) were not employed at the time of follow-up; 19 (68%) of the 28 reported that the pilon fracture prevented them from working.
Multivariate analyses revealed that presence of 2 or more comorbidities, being married, having an annual personal income of less than $25,000, not having attained a high-school diploma, and having been treated with external fixation with or without limited internal fixation were significantly related to poorer results as reflected by at least 2 of the 5 primary outcome measures.

Conclusions

At more than three years after the injury, pilon fractures can have persistent and devastating consequences on patients' health and well-being. Certain social, demographic, and treatment variables seem to contribute to these poor outcomes.

Level of evidence: Prognostic study, Level II-1 (retrospective study). Copyright remains with the authors and publisher.

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