Hong Choon Chiet, Tan Si Heng Sharon, Saha Soura, Pearce Christopher Jon
Department of Orthopaedic Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore.
Arch Orthop Trauma Surg. 2023 Jun;143(6):2855-2862. doi: 10.1007/s00402-022-04456-8. Epub 2022 May 6.
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.
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.
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.
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.
本研究的主要目的是从患者角度描述胫骨平台骨折相关的后遗症和发病率，内容涉及多次手术干预、住院时间、停工时间、生产力损失以及对患者生活的影响。次要目的是回顾这些发病率的相关危险因素。
纳入2007年7月1日至2017年6月30日期间接受手术治疗的所有胫骨平台骨折患者。所回顾的发病率集中在手术延迟、手术次数、肢体截肢、住院时间（LOS）、再入院、病假时长（ML）、随访及门诊就诊次数。
本综述纳入了102例患者，其中高达70%的患者平均延迟7天进行确定性手术。他们平均住院时间至少为2周，如果需要进行软组织重建，则会延长至3周以上。高达三分之一的患者再次入院，其中15%需要进一步治疗。这些患者需要较长时间的停工，病假时长较长（平均152.6天 [标准差 = 110.7]）。多个条件回归模型显示，AO/OTA分类（B型和C型）及开放性骨折是手术延迟的独立预测因素。住院时间延长的预测因素为高速损伤机制（延长4天）以及需要进行软组织重建的患者（延长21天）。在停工时间方面，仅工伤被确定为病假时长延长的独立预测因素（延长88.5天）。
胫骨平台骨折会导致严重的发病率，在所需的多次手术干预、延长的住院时间、再次入院需求以及长时间的停工方面，对患者生活产生深远的负面影响。从患者角度来看，应向患者和雇主强调这些发病率，以管理他们的期望和潜在限制。
