Evaluating Fracture Healing in Tibial Plafond Injuries: RUST Score Analysis after ORIF and MIPO with Adjuvant Teriparatide Therapy.

Abstract

Fracture healing remains a complex and multifactorial biological process, influenced by mechanical stability, vascular supply, and biological environment. The aim of this study was to assess whether statistically significant prognostic differences in fracture healing exist between ORIF and MIPO after teriparatide therapy, using the RUST scores. Twenty seven patients with tibial plafond fractures were divided into two groups: 14 treated with ORIF and 13 with MIPO. All patients received postoperative teriparatide injections. Functional outcomes were assessed using the AOFAS score, and quality of life was evaluated with SF-12 and VAS. Continuous data were analyzed using Student's t-test, with statistical significance set at p <.05. VAS and RUST scores showed moderate correlation (.001 < p < .034). Postoperative AOFAS scores initially declined, with significant difference favoring MIPO (p = .024), but converged by 6 months. At 6 months, ORIF demonstrated higher RUST all cortices (p = .035) and medial-lateral (p = .001), with no difference in anterior-posterior. ORIF may achieve superior cortical consolidation and alignment versus MIPO. The ORIF group demonstrated superior bone consolidation, as indicated by higher RUST in cortical 4 and medial-lateral (M-L) views (P=.035 and P=.001). Despite these differences, clinical outcomes depend on fracture type, patient health, and surgical timing. ORIF should be considered the preferred approach for complex tibial plafond fractures. ORIF may offer advantages in anatomical reduction and bone healing over MIPO in tibial plafond fractures, with comparable clinical outcomes. The authors believe that teriparatide was a useful adjuvant in the healing of pilon fractures.