ArticleBone & joint open2021
A multicentre, randomized, parallel group, superiority study to compare the clinical effectiveness and cost-effectiveness of external frame versus internal locking plate for complete articular pilon fracture fixation in adults.
Article in Bone & joint open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
11 citing papers in PubMed, 17 citations in OpenAlex.
- Timing of Fracture Fixation in Ankle Fracture-Dislocations.Foot & ankle specialist · 2026Article
- Outcomes of the hexapod frame in 111 'high risk' tibial fractures.Bone & joint open · 2025Article
- What is a tibial pilon fracture and how should they be acutely managed? A survey of consultant British Orthopaedic Foot and Ankle Society members and non-members.Annals of the Royal College of Surgeons of England · 2025Article
- The acute management of Pilon fractures (ENFORCE) study: a national evaluation of practice.Annals of the Royal College of Surgeons of England · 2025Observational
- Fracture Line Morphology and a Novel Classification of Pilon Fractures.Orthopaedic surgery · 2025Article
- Undertaking Studies Within A Trial to evaluate recruitment and retention strategies for randomised controlled trials: lessons learnt from the PROMETHEUS research programme.Health technology assessment (Winchester, England) · 2024Article
- Development of a nomogram to predict surgical site infection after open reduction and internal fixation for closed pilon fracture: a prospective single-center study.Journal of orthopaedic surgery and research · 2023Article
- [Effectiveness of new Pilon plate in treatment of type C Pilon fracture].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2023Article
- Fine wire versus locking plate fixation of type C pilon fractures.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2022Article
- Integrated care systems in trauma to elective care: Can we emulate the integration of services in orthopaedic trauma care within elective practice?Bone & joint open · 2021Article
- Clinical and Functional Outcomes in Patients with Distal Tibial Fracture Treated by Circular External Fixation: A Retrospective Cohort Study.Strategies in trauma and limb reconstructionArticle
Corrections and comments
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Authors and funding
23 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsA pilon fracture is a severe ankle joint injury caused by high-energy trauma, typically affecting men of working age. Although relatively uncommon (5% to 7% of all tibial fractures), this injury causes among the worst functional and health outcomes of any skeletal injury, with a high risk of serious complications and long-term disability, and with devastating consequences on patients' quality of life and financial prospects. Robust evidence to guide treatment is currently lacking. This study aims to evaluate the clinical and cost-effectiveness of two surgical interventions that are most commonly used to treat pilon fractures.
methodsA randomized controlled trial (RCT) of 334 adult patients diagnosed with a closed type C pilon fracture will be conducted. Internal locking plate fixation will be compared with external frame fixation. The primary outcome and endpoint will be the Disability Rating Index (a patient self-reported assessment of physical disability) at 12 months. This will also be measured at baseline, three, six, and 24 months after randomization. Secondary outcomes include the Olerud and Molander Ankle Score (OMAS), the five-level EuroQol five-dimenison score (EQ-5D-5L), complications (including bone healing), resource use, work impact, and patient treatment preference. The acceptability of the treatments and study design to patients and health care professionals will be explored through qualitative methods. DISCUSSION: The two treatments being compared are the most commonly used for this injury, however there is uncertainty over which is most clinically and cost-effective. The Articular Pilon Fracture (ACTIVE) Trial is a sufficiently powered and rigorously designed study to inform clinical decisions for the treatment of adults with this injury. Cite this article:
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