Fri., 10/19/07 Foot & Ankle, Paper #37, 3:53 pm OTA-2007
The Sequential Recovery of Health Status after Tibial Plafond Fractures
J. Lawrence Marsh, MD (n); Todd O. McKinley, MD (n); Douglas R. Dirschl, MD (n);
Andrew G. Pick, BS (n); Geoffrey Haft, MD (n); Donald D. Anderson, PhD (n);
Thomas D. Brown, PhD (n);
University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Purpose: This study assesses the sequential recovery of general health status and the degree of ankle pain and function at multiple time points during the first 24 months after an isolated tibial plafond fracture. Assessing patients at scheduled time points provides outcome information as a function of time after fracture. This information is important to counsel patients regarding the expectations for their ankle and general health status at various points postinjury.
Methods: 81 patients with fractures of the tibial plafond (January 2000 to August 2005) treated with external and limited internal fixation were followed prospectively for 24 months after fracture. During the follow-up visits, patients completed the Short-Form 36 (SF-36) at 1, 2, 3, 6, 12, and 24 months and the Ankle Osteoarthritis Score (AOS) at 6, 12, and 24 months after injury. From this database, 46 patients with unilateral fractures completed the 24-month follow-up and did not miss more than two previous follow-up appointments.
Results: Some of the outcomes plateaued by 6 months while others continued to improve out to 24 months after injury. The mental component score (MCS) of the SF-36 plateaued first, reaching age-matched norms by 6 months, and did not change with further follow-up. These scores significantly improved between 1 and 2 and 3 and 6 months. The physical component score (PCS) of the SF-36 plateaued by 12 months but remained one standard deviation below age-matched norms. These scores significantly improved between 3 and 6 and 6 and 12 months. Unlike the SF-36, the pain and disability components of the AOS deteriorated between 6 and 12 months as patients began to function on their ankle and then improved between 12 and 24 months.
Conclusion and Significance: The data in this study provide a generalized interpretation of the course to recovery from these fractures. The MCS improves quickly, suggesting that patients cope and adapt despite decreased ankle function. PCS improves between 3 months and 1 year but does not further improve in the second year, suggesting a plateau by 1 year. The joint-specific outcomes (AOS) tracked the opposite way, deteriorating between 6 and 12 months and then improving between 12 and 24 months. One explanation is that when the patient’s PCS improved between 6 and 12 months (started to walk again), their ankle became more painful. Between 12 and 24 months, ankle pain decreased and function improved. The trends in this data could be used to counsel patients. They could expect that their mental health would return to normal within a few months, but their general physical health would take 1 year and their ankle 2 years to reach a plateau. Neither their ankle pain and function nor their general physical health would return to preinjury status.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.