Subtalar Arthritis After Pilon

Pilon fractures frequently lead to ankle arthritis. However, the risk and severity of posttraumatic subtalar arthritis is not well documented. This is relevant considering the evolving trend of acute of tibiotalocalcaneal (TTC) arthrodesis as a treatment option.

Study design

To better understand subtalar arthritis after pilon fractures, researchers conducted a retrospective review of 473 patients with pilon fractures treated by open reduction internal fixation. Patients were grouped based on time since injury to final imaging (1-12, 12–24, 25–48, 48+ months) and subtalar arthritis was graded using Kellgren-Lawrence (K-L), NSS (None, Some, Severe), and CT Ankle Osteoarthritis (CTAO) systems. 

Key findings

The study found that:

• Subtalar arthritis worsened over time after injury.

• More severe arthritis was associated with older age, smoking, steroid use, higher comorbidity burden (CCI), and more severe fracture patterns (AO/OTA).

• Patients imaged 25+ months post-injury had significantly worse arthritis than those examined earlier.

• CTAO scores correlated with patient age at injury and imaging.

Takeaway

Subtalar arthritis after pilon fracture progresses over time and is largely driven by patient characteristics and injury factors. These findings suggest acute TTC nailing may have a role for a defined subset of tibial pilon fractures.