Association of Resilience with Clinical and Patient-Reported Outcomes Following Operative Fixation of Pilon Fractures

OBJECTIVE: To evaluate the association between resilience, as measured by the Brief Resilience Scale (BRS), and both clinical and patient-reported outcomes (PROs) following operative fixation of pilon fractures. METHODS: Design : Retrospective cohort study. Setting: Single Level I trauma center. Patient selection criteria: Adult patients (≥18 years) with AO/OTA 43 pilon fractures treated operatively between 2022 and 2026 were included. Patients without postoperative PROs or a 6-month BRS were excluded. Patients were stratified by median 6-month BRS into low (<3.67) and high (≥3.67) resilience groups. Outcome measures and comparisons: Patient-Reported Outcomes Measurement Information System domains (global physical health [GPH], global mental health [GMH], physical function [PF], pain interference [PI], depression, anxiety) and percent of normal function at multiple postoperative timepoints (6 weeks, 3 months, 6 months, 1 year, 2 years). Clinical outcomes included reoperation, fracture-related infection, nonunion, and amputation. Outcomes were compared between resilience groups. RESULTS: A total of 105 patients were included (low resilience: n = 48; high resilience: n = 57). Low- and high-resilience groups were similar in age (46.7 [range, 20.0-76.9] vs 51.6 years [range: 18.5-88.7], respectively), BMI (29.6 vs 30.7 kg/m 2 , respectively), sex (52.1% vs 42.1% male respectively), and race (60.4% vs 73.7% White, respectively), although patients in the low-resilience group demonstrated higher ISS (15.8 vs 9.8, p < 0.001). Compared with the low-resilience group, the high-resilience group demonstrated higher GMH at all timepoints (all p ≤ 0.021), while depression and anxiety scores were lower at 6 weeks, 3 months, and 6 months (all p ≤ 0.019). Compared with the low-resilience group, the high-resilience group also demonstrated higher GPH and PF scores and lower PI scores at 3 and 6 months (all p ≤ 0.045), as well as higher percent of normal function at 6 months (51.7% vs 40.5%, p = 0.040). CONCLUSION: Higher resilience was associated with improved PROs following operative fixation of pilon fractures, with differences observed early and persisting over time. Resilience represents an important patient-specific factor associated with recovery and may provide additional context when interpreting postoperative outcomes. LEVEL OF EVIDENCE: III