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Morbidities and prognostic factors after tibial pilon fracture: impact on patients

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

This study aims primarily to characterize the sequelae and morbidity associated with tibial pilon injuries from the patients’ perspectives in terms of multiple surgical interventions, duration of hospital stay, downtime from work, loss of productivity and impact on patients’ lives. The secondary aim is to review the associated risk factors for these morbidities.

Materials and methods

All patients with surgically treated tibial pilon fractures from 1st July 2007 to 30th June 2017 were included. The morbidities reviewed focused on delay to surgery, numbers of surgeries, limb amputation, length of stay (LOS), readmissions, duration of medical leave (ML), follow-up and number of outpatient visits.

Results

There were 102 patients included in the review and up to 70% of them had an average 7 days delay to definitive surgery. They also required an average hospital LOS of at least 2 weeks extending up to 3 more weeks if soft tissue reconstruction was necessitated. Up to a third of patients were readmitted with 15% of them needing further treatment. These patients required a notable period of downtime from work as shown in the long ML (mean 152.6 days [S.D. = 110.7]). Multiple conditional regression models showed AO/OTA classification (B and C) and open fracture as independent predictors of delay to surgery. Predictors for increased LOS were high velocity mechanism of injury at 4 days longer and patients who needed soft tissue reconstruction at 21 days longer. In terms of downtime from work, only work injury has been identified as an independent predictor of ML at 88.5 days longer.

Conclusion

Tibial pilon fractures leads to significant morbidities with profound negative impact on patients’ lives in terms of multiple surgical interventions required, prolonged hospital stay, need for readmissions and prolonged downtime from work. These morbidities from patients’ perspective should be emphasized to patients and employers to manage their expectations and potential limitations.

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Acknowledgements

The authors would like to acknowledge Dr Fareed Kagda, Dr Diarmuid Murphy, Dr Chee Yu Han and Dr Gavin O’Neill, some of whose cases were also included in the study data.

Funding

There is no funding for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Choon Chiet Hong

  2. Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore

    Si Heng Sharon Tan, Soura Saha & Christopher Jon Pearce

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  1. Choon Chiet Hong
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  2. Si Heng Sharon Tan
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  3. Soura Saha
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  4. Christopher Jon Pearce
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CCH, SS and SHST. The first draft of the manuscript was written by CCH and all authors commented on previous versions of the manuscript. CJP supervised and reviewed the final manuscript. All authors read and approved the final manuscript.

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Correspondence to Choon Chiet Hong.

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Hong, C.C., Tan, S.H.S., Saha, S. et al. Morbidities and prognostic factors after tibial pilon fracture: impact on patients. Arch Orthop Trauma Surg 143, 2855–2862 (2023). https://doi.org/10.1007/s00402-022-04456-8

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  • DOI: https://doi.org/10.1007/s00402-022-04456-8

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