Pilon Fracture Outcomes: A Retrospective Review

Research Type: Level 4 – Case series Introduction/Purpose: Pilon fractures pose a significant challenge in orthopedics with regards to soft tissue management and patient outcomes. This study aims to examine risk factors that may be associated with adverse outcomes in the treatment of pilon fracture, most specifically the timing of definitive fixation. Methods: A retrospective chart review was performed with patients 18 years or older treated for pilon fracture from May 2016 through December 2020, identified by OTA classification 43A-C from a single ACS Level 1 Trauma Center Fracture Registry. Univariate statistics were performed and logistic regression with stepwise selection used to identify variables associated with unplanned return to the OR (uRTOR) and incidence of any postoperative complications, including wound dehiscence, wound drainage, soft tissue breakdown, superficial or deep infection, nonunion, symptomatic hardware, or compartment syndrome. Results: 340 fractures met inclusion criteria. 32.4% were polytrauma patients. 21.8% of these fractures were open at the time of initial presentation. Time to definitive fixation when treated without staged fixation was 2.7±5.7 days (n = 278). Time to definitive fixation after external fixation was 25.3±41.6 days (n = 62). Significant factors predictive of postoperative complication included smoking (63.2% vs. 33.6%), depression (26.3% vs. 9.7%), open fracture (52.6% vs. 19.9%), discharge to locations other than home or rehab (26.3% vs. 6.3%). 43/340 patients had an uRTOR within 1 year. Significant factors predictive of uRTOR included smoking (48.4% vs. 33.3%), CAD (9.3% vs. 2.0%), depression (20.9% vs. 9.1%), open fracture (44.2% vs. 18.5%), and discharge to locations other than home or rehab (19.0% vs. 5.8%). Conclusion: Factors predictive of pilon fracture complications or uRTOR aide in patient expectation management, treatment, and postoperative planning. Early definitive fixation was not predictive of these adverse outcomes.