JOT - 2026-09-09 - Journal Article
Association of Resilience with Clinical and Patient-Reported Outcomes Following Operative Fixation of Pilon Fractures.
Litten RM, McIlwain RN, Alders AN, Asad S, Spitler CA, Johnson MD, Johnson JP
Topics
Key Takeaway
High resilience (BRS ≥3.67) was associated with 11.2 percentage points greater normal function at 6 months (51.7% vs 40.5%, p=0.040) and superior PROMIS scores across all mental health domains at every timepoint following operative pilon fracture fixation.
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Summary
This single Level I trauma center retrospective cohort study evaluated whether 6-month Brief Resilience Scale scores predicted clinical and PROMIS outcomes in 105 operatively treated AO/OTA 43 pilon fractures, stratified at median BRS 3.67. High-resilience patients demonstrated superior PROMIS global mental health at all timepoints (all p≤0.021), lower depression and anxiety through 6 months (all p≤0.019), and higher global physical health, physical function, and lower pain interference at 3 and 6 months (all p≤0.045). No significant between-group differences in clinical outcomes (reoperation, FRI, nonunion, amputation) were reported.
Key Limitation
The BRS was administered at 6 months postoperatively rather than preoperatively, making it impossible to determine whether low resilience caused worse outcomes or whether worse early outcomes depressed resilience scores, fundamentally limiting causal inference.
Original Abstract
OBJECTIVE
To evaluate the association between resilience, as measured by the Brief Resilience Scale (BRS), and both clinical and patient-reported outcomes (PROs) following operative fixation of pilon fractures.
METHODS
Design: Retrospective cohort study.
SETTING
Single Level I trauma center.
PATIENT SELECTION CRITERIA
Adult patients (≥18 years) with AO/OTA 43 pilon fractures treated operatively between 2022 and 2026 were included. Patients without postoperative PROs or a 6-month BRS were excluded. Patients were stratified by median 6-month BRS into low (<3.67) and high (≥3.67) resilience groups.
OUTCOME MEASURES AND COMPARISONS
Patient-Reported Outcomes Measurement Information System domains (global physical health [GPH], global mental health [GMH], physical function [PF], pain interference [PI], depression, anxiety) and percent of normal function at multiple postoperative timepoints (6 weeks, 3 months, 6 months, 1 year, 2 years). Clinical outcomes included reoperation, fracture-related infection, nonunion, and amputation. Outcomes were compared between resilience groups.
RESULTS
A total of 105 patients were included (low resilience: n = 48; high resilience: n = 57). Low- and high-resilience groups were similar in age (46.7 [range, 20.0-76.9] vs 51.6 years [range: 18.5-88.7], respectively), BMI (29.6 vs 30.7 kg/m2, respectively), sex (52.1% vs 42.1% male respectively), and race (60.4% vs 73.7% White, respectively), although patients in the low-resilience group demonstrated higher ISS (15.8 vs 9.8, p < 0.001). Compared with the low-resilience group, the high-resilience group demonstrated higher GMH at all timepoints (all p ≤ 0.021), while depression and anxiety scores were lower at 6 weeks, 3 months, and 6 months (all p ≤ 0.019). Compared with the low-resilience group, the high-resilience group also demonstrated higher GPH and PF scores and lower PI scores at 3 and 6 months (all p ≤ 0.045), as well as higher percent of normal function at 6 months (51.7% vs 40.5%, p = 0.040).
CONCLUSION
Higher resilience was associated with improved PROs following operative fixation of pilon fractures, with differences observed early and persisting over time. Resilience represents an important patient-specific factor associated with recovery and may provide additional context when interpreting postoperative outcomes.
LEVEL OF EVIDENCE
III.