Evidence map›Paper›PMID 41225168›Full record

Trial reportInternational orthopaedics2026

Comparison of two-stage open reduction and internal fixation and single-stage external fixation for complex pilon fractures: a randomized controlled trial.

Mohamed Osama Eissa, Mootaz Fouad Thakeb, Salah AbouSeif, Tamer A Fayyad, M A Alkersh, Mohamed A ElGebeily, Ahmad Saeed Aly, Mostafa M Baraka

Registry-linked trialAbstract readRandomized Controlled TrialComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in International orthopaedics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05141227 (Two-stage Open Reduction and Internal Fixation Versus Single-stage External Fixation for Complex Intra-articular Distal Tibial Fractures), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05141227 nacompletednot on this map

Two-stage Open Reduction and Internal Fixation Versus Single-stage External Fixation for Complex Intra-articular Distal Tibial Fractures : A Randomized Controlled Trial

TypeinterventionalSponsorAin Shams UniversityRan2021 to 2024Enrolled60ConditionsPilon FractureArmsTwo-stage Open reduction and internal fixation ( ORIF) using plates & screws, single-stage external fixation (EX.FIX.) with minimal internal fixation using cannulated screws if needed
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Mohamed Osama EissaDepartment of orthopedic surgery, Ain Shams University, Cairo, Egypt. mohamed.eissa@med.asu.edu.eg.
Mootaz Fouad ThakebDepartment of orthopedic surgery, Ain Shams University, Cairo, Egypt.
Salah AbouSeifDepartment of orthopedic surgery, Ain Shams University, Cairo, Egypt.
Tamer A FayyadDepartment of orthopedic surgery, Ain Shams University, Cairo, Egypt.
M A AlkershDepartment of orthopedic surgery, Ain Shams University, Cairo, Egypt.
Mohamed A ElGebeilyDepartment of orthopedic surgery, Ain Shams University, Cairo, Egypt.
Ahmad Saeed AlyDepartment of orthopedic surgery, Ain Shams University, Cairo, Egypt.
Mostafa M BarakaDepartment of orthopedic surgery, Ain Shams University, Cairo, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo compare functional and radiological outcomes between two stage ORIF and single stage external fixation for complex pilon fractures.

methodsProspective, single-center randomized controlled trial at a Level I trauma facility (April 2021-April 2023). Sixty skeletally mature patients with AO/OTA 43-C pilon fractures unsuitable for primary ORIF were randomized to two-stage ORIF (control group) or single-stage limited internal fixation with external fixation (LIFEF) (treatment group). Minimum follow-up was 24 months. The primary outcome was the AOFAS score at final follow-up. Secondary outcomes included time to union, time to return to work, ankle range of motion (ROM), fracture-related infection (FRI), bone-healing complications (nonunion, malunion, delayed union), post-traumatic osteoarthritis (PTOA), and need for secondary procedures.

resultsAll 60 patients completed follow-up. Compared with LIFEF, two-stage ORIF achieved higher AOFAS scores (85 ± 9 vs. 77 ± 10; P = 0.006), earlier return to work (7 ± 1.5 vs. 10 ± 3 months; P < 0.001), and shorter time to union (17 ± 3.6 vs. 19 ± 3.5 weeks; P = 0.02). Groups did not differ in quality of reduction (P = 0.14), ankle ROM (P = 0.10 and 0.058 for dorsiflexion and plantarflexion), FRI (P = 0.69), PTOA (P = 0.64), or bone-healing complications (nonunion, delayed union, malunion; P = 0.24, 0.39, 0.39).

conclusionTwo-stage ORIF provided superior functional outcomes and faster recovery (earlier union and return to work) compared with LIFEF, with similar reduction quality and complication rates. These findings support two-stage ORIF as the preferred strategy for AO/OTA 43-C pilon fractures with soft-tissue compromise. REGISTRY: ClinicalTrials.gov , NCT05141227, Registration date: 29 July 2021.

Indexed as

Ankle FracturesFracture FixationFracture Fixation, InternalOpen Fracture ReductionTibial FracturesAdultExternal FixatorsFemaleFracture HealingHumansMaleMiddle AgedProspective StudiesRange of Motion, ArticularReturn to WorkTreatment OutcomeDamage controlExternal fixationPilon fractureStaged ORIF

Identifiers

PMID41225168
PMCPMC12881023

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.