Ryan Thomas J, Enninghorst Natalie, Partridge Jessica, Sulemain Ahmed, Du Plessis Jacqueline, Henry Chris, Weaver Natasha, Tarrant Seth M, Balogh Zsolt J
Department of Orthopaedics, John Hunter Hospital, Newcastle, New South Wales, Australia.
Discipline of Surgery, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.
ANZ J Surg. 2025 Jun;95(6):1247-1252. doi: 10.1111/ans.70164. Epub 2025 May 10.
Pilon fractures are historically associated with suboptimal outcomes. No long-term Australian data is available on patient-reported outcomes. We hypothesised that pilon fracture long-term outcomes are inferior to Australian population norms.
A 14-year retrospective study was conducted in a Level-1 trauma centre on AO/OTA type-B/C fractures. Type-A fractures, skeletally immature, interpreter requirement and primary amputation were excluded. Demographics, injury characteristics, management and complications were collected. The primary outcome was SF-36 with adjusted Australian norms.
From 127 eligible patients, 73 were included in the study (age: 46 ± 17 years; 50 [69%] males) with 8.7 ± 3.9 years follow-up. Management included ORIF 46 (61%), external fixation (EF) with staged ORIF 17 (23%), definitive EF 4 (5%) and 8 (11%) non-operative. Further surgical intervention was required in 25 (34%) patients, with the majority for hardware removal (14 [19%]). Compared with Australian SF-36 norms, the mean Physical Component Score was lower (44.7 ± 8.9 vs. 50.3, p ≤ 0.001) whereas the Mental Component Score (51.2 ± 12.5 vs. 51.2, p = 0.24) was not. Median return to work was 4.5 months (IQR 5), with 47 (87%) of the 54 employed pre-injury working at 12 months. Two (3.7%) patients did not return to work and 24 (44%) returned at a reduced capacity.
This study provides a contemporary reference for pilon fractures managed in Australia. Outcomes were favourable when compared internationally. These patients are likely to resume employment, often at reduced capacity, while experiencing moderate long-term impacts to their physical well-being due to persistent pain.
从历史上看，Pilon骨折的治疗效果欠佳。目前尚无澳大利亚关于患者报告结局的长期数据。我们推测Pilon骨折的长期结局不如澳大利亚人群的正常水平。
在一家一级创伤中心对AO/OTA B/C型骨折进行了一项为期14年的回顾性研究。排除A型骨折、骨骼未成熟、需要口译以及一期截肢的病例。收集了人口统计学资料、损伤特征、治疗方法及并发症。主要结局指标为根据澳大利亚正常水平进行调整后的SF-36量表评分。
127例符合条件的患者中，73例纳入研究（年龄：46± 岁；男性50例[69%]），随访时间为8.7± 3.9年。治疗方法包括切开复位内固定术（ORIF）46例（61%）、外固定（EF）联合分期ORIF 17例（23%）、确定性EF 4例（5%）以及非手术治疗8例（11%）。25例（34%）患者需要进一步手术干预，大多数是为了取出内固定物（14例[19%]）。与澳大利亚SF-36量表的正常水平相比，平均身体状况评分较低（44.7± 8.9对50.3，p≤ 0.001），而精神状况评分（51.2± 12.5对51.2，p=0.24）无差异。中位重返工作时间为4.5个月（四分位间距5），受伤前就业的54例患者中有47例（87%）在12个月时恢复工作。2例（3.7%）患者未恢复工作，24例（44%）以较低的工作能力恢复工作。
本研究为澳大利亚治疗的Pilon骨折提供了当代参考。与国际上相比，结局良好。这些患者可能会恢复工作，通常工作能力较低，同时由于持续疼痛，其身体健康受到中度长期影响。
