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Improvements from ORIF of pilon fractures plateau in short-term follow-up

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SAN DIEGO — Patients who underwent open reduction internal fixation of pilon fractures and had a minimum 2-years follow-up showed increased ankle range of motion during 12 months postoperatively which then declined through 36-months follow-up, according to a study presented here.

David A. Volgas, MD, presented the results at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. He noted that his team also found a similar drop-off or plateau in pain relief and other subjective scores among the 56 patients in the prospective longitudinal study who completed all follow-up visits. The study originally enrolled 115 patients who were treated by a single surgeon with staged open reduction internal fixation (ORIF) between January 2007 and January 2009.

Volgas said several patients who rated their pain as a 10 on a 10-point scale at the outset of the study reported the same level of pain at 1 year after treatment. “The pain scores did not reliably improve in any of these patients,” he said. “The strength then is this is one of the first studies I know about that focuses on this time period and this early recovery period. It may guide surgeons and patients a little bit more about what to expect early on,” he said.

Volgas cited the study’s poor follow-up as its chief weakness. Although the investigators attempted to determine how pain and function related to pilon fractures impacted patients’ return to work, he said, “We were unsuccessful in this study in determining who were the people who could return to work.”

Physical therapy did not notably affect function, and any improvements peaked by 12 months postoperatively and started to decline by 36 months, based on the study.

Reference:

• Volgas DA, Stewart R, Stannard JP. Longitudinal outcomes of pilon fractures. Paper #385. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19, 2011. San Diego.

Disclosure: Volgas has no relevant financial conflicts.

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