Raveena Joshi (Boston, MA / US), Surbhi Srinivas (Boston, MA / US), Colin O’Neill (Boston, MA / US), Abhinav Bhamidipati (Boston, MA / US), Daniel Acevedo (Boston, MA / US), Kevin Wang (Boston, MA / US), Soheil Ashkani-Esfahani (Boston, MA / US), John Kwon (Boston, MA / US)
Introduction: Post-traumatic ankle arthritis is a common complication after pilon fractures. However, whether pilon fractures lead to an increased risk of subtalar arthritis has not been explored. Increasingly, primary tibio-talar or tibio-talar-calcaneal arthrodesis is being utilized for more severe injuries. Both interventions have implications for the subtalar joint, thus the natural history of subtalar arthritis following pilon fracture may shed light on the appropriateness of these interventions.
Material and Methods: Adult patients ≥18 years old operatively treated for a pilon fracture at our institution were eligible for inclusion. Patients were excluded if they were treated with primary arthrodesis or if they had concurrent talus or calcaneus fractures. Patient radiographs were evaluated for subtalar arthritis using the Kellgren-Lawrence (K-L) score and the None, Some, Severe (NSS) Scale.
Results: Data was collected on 474 fractures. Patients were grouped according to the amount of time between their initial injury and most recent radiographs. Groups 1 to 4, correspond respectively to patients <12 months, 12 –24 months, 25 – 48 months, and >48 months between the date of pilon fracture and their latest imaging. Patients in group 3 had a significantly higher average K-L score than those in group 1 (mean difference (MD) 0.34, 95% confidence interval (CI) 0.03 to 0.66, p = 0.04) and 2 respectively (MD 0.39, 95% CI 0.05 to 0.73, p = 0.02). Patients in group 4 had a significantly higher average K-L score than those in group 1 (MD 0.37, 95% CI 0.08 to 0.66, p = 0.01) and group 2 respectively (MD 0.42, 95% CI 0.11 to 0.73, p = 0.009)
Conclusions: While there was no significant difference in NSS scores across the 4 groups, our study found a significant increase in radiographic subtalar osteoarthritis after 24 months following a pilon fracture according to the K-L scoring scale. This suggests a potential association between pilon fractures and subtalar arthritis.
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