Association of Resilience with Clinical and Patient-Reported Outcomes Following Operative Fixation of Pilon Fractures.

Authors

Robin M Litten, Ryan N McIlwain, Alexis N Alders, Shaheryar Asad, Clay A Spitler, Michael D Johnson, Joey P Johnson

Published in

Journal of orthopaedic trauma. Sep 09, 2026. Epub Sep 09, 2026.

Abstract

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.
Design: Retrospective cohort study.
Single Level I trauma center.
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.
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.
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).
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.
III.

PMID:
42715161
Bibliographic data and abstract were imported from PubMed on 10 Sep 2026.

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