Clinical Outcomes for Pilon Variant Posterior Malleolar Fractures: A Multicenter Retrospective Analysis

Black, Alexandra T.; Stowers, Jered M.; Tran, Son; Mata, Karla De La; Sherman, Alain E.; RahnamaVaghef, Ali

doi:10.1053/j.jfas.2022.04.007

Cited by 4 publications

(2 citation statements)

References 31 publications

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“…We noticed a positive association between age and VAS in female patients of our study, and found that the proportion of female patients with PVPM fractures (58 of 90 cases, 64.44%) was signi cantly higher than the female percentage of ankle fractures (246 of 490 cases, 50.41%) or that of posterior malleolar fractures (116 of 211 cases, 54.98%). Not only females were relatively more dominant than males by consisting of ankle fracture cohort, females were injured at more advanced age, which was consistent with previous conclusion that ankle fractures affect younger men and older women [22,23] . One possibility of middle-aged female being prone to PVPM fracture is the lower bone density led susceptibility under low-energy violence.…”

Section: Discussionsupporting

confidence: 91%

A Retrospective Study of the Clinical Outcomes of Pilon Variant Posterior Malleolar Fracture involving Intra-Articular Impacted Fragments

You

Chen

Sun

et al. 2023

Preprint

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INTRODUCTION Intra-articular impacted fragment (IAIF) is commonly found in the Pilon variant posterior malleolar (PVPM) fracture. Poor quality of reduction may result in articular incongruity, leading to ankle function impairment and ultimately traumatic arthritis. However, the debating remains on if the IAIF must be reduced, and how the presence or malreduction of the IAIF influences the prognosis in PVPM fractures. This retrospective study is to evaluate the prognostic effect of the IAIF reduction in the PVPM fractures. METHODS We studied 22 patients with PVPM fractures admitted to our hospital between June 2020 and June 2021, who were treated with open surgery and followed-up for 12 months retrospectively. The patients were divided into two groups: six patients without IAIF (No-IAIF group) and 16 patients with IAIF (IAIF group). Burwell-Charnley scoring system and ankle CT scan were used to evaluate the radiographic outcomes. At postoperative 12 months, American Orthopedic Foot and Ankle Score (AOFAS) was set as primary outcome. Visual Analog Scale (VAS) pain score, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were secondary outcomes and associated complications were recorded. Postoperative articular stepping ≥2mm or articular incongruity on the sagittal view of CT scans was considered “poor” reduction, otherwise “anatomical”. The study abided by the Declaration of Helsinki and is approved by Human Ethics Committee of our hospital. All persons gave their informed consent prior to their inclusion in the study. RESULTS The articular surface of five of six patients in No-IAIF group and eight of 16 patients in IAIF group were considered “anatomically” reduced. Statistical difference of AOFAS, SF-36 and VAS was found significant between the No-IAIF and IAIF groups at postoperative 12 months. In the fractures considered with “anatomical” reduction, significant difference was only seen in SF-36 between the patients with and without IAIF. Three of 22 patients received syndesmotic fixations. No difference of associated complications was noted. DISCUSSION The results of this study indicated that the short-term clinical effect was dependent of the presence the IAIF. Importantly, the reduction satisfactory was statistically associated with improved clinical outcomes at 12 months postoperatively. SIGNIFICANCE The presence of the IAIF negatively affect the clinical outcome and the anatomical reduction of the articular congruity will positively affect the prognosis of PVPM fracture.

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Section: Discussionsupporting

confidence: 91%

A Retrospective Study of the Clinical Outcomes of Pilon Variant Posterior Malleolar Fracture involving Intra-Articular Impacted Fragments

You

Chen

Sun

et al. 2023

Preprint

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“…Meanwhile, the treatment for this fracture type has been increasingly reported and remains a challenge. However, the best surgical approach for posterior pilon fractures has not been determined ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of posterior pilon fractures using a simple single lateral approach via stretching fibular fracture line

et al. 2023

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PurposeThe aim of this study was to explore the treatment outcomes of a novel single lateral approach via fibular fracture line for patients with posterior pilon fractures.Patients and methodsFrom January 2020 to December 2021, a total of 41 patients with posterior pilon fractures who received surgical treatment in our hospital were retrospectively reviewed. Twenty patients (Group A) were treated with open reduction and internal fixation (ORIF) via posterolateral approach. Twenty-one patients (Group B) were treated with ORIF using a simple single lateral approach via stretching fibular fracture line. Clinical assessments, including operation time, intraoperative blood loss, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), and the active range of motion (ROM) of the ankle at the final follow-up visit after surgery, were performed in all patients. Radiographic outcome was evaluated by using the criteria proposed by Burwell and Charnley.ResultsThe mean follow-up time was 21 months (range 12–35). The average operation time and intraoperative blood loss in the Group B were significantly less than those in the Group A. Moreover, the AOFAS score and ankle ROM in the Group B were significantly higher than those in the Group A at the final follow-up visit. Eighteen cases (90%) in Group A and 19 cases (90.5%) in Group B achieved anatomical reduction of the fracture.ConclusionThe single lateral approach via stretching fibular fracture line is a simple and effective technique for reduction and fixation of posterior pilon fractures.

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A systematic review of posterior pilon variant fractures

Lassiter,

Brown,

Patel

et al. 2024

Journal of Orthopaedics

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Clinical Outcomes for Pilon Variant Posterior Malleolar Fractures: A Multicenter Retrospective Analysis

Cited by 4 publications

References 31 publications

A Retrospective Study of the Clinical Outcomes of Pilon Variant Posterior Malleolar Fracture involving Intra-Articular Impacted Fragments

A Retrospective Study of the Clinical Outcomes of Pilon Variant Posterior Malleolar Fracture involving Intra-Articular Impacted Fragments

Treatment outcomes of posterior pilon fractures using a simple single lateral approach via stretching fibular fracture line

A systematic review of posterior pilon variant fractures

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