Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Despite the assumption of the rigid construct of the TSF, the median time to union was similar to that of the Ilizarov frame and the TSF therefore can play a significant role in complex tibial fractures.

In tro duc tion. Intramedullary nail is an im por tant com po nent of mod ern treat ment of pertrochanteric fe mur frac tures. Ob jec tive. In el derly pop u la tion, pertrochanteric frac tures treated with unreamed intramedullary nails cause less deep in fec tions when com pared to reamed intramedullary nails. Pa tients and Meth ods. From April, 2010 to May, 2012 at the De part ment of Or tho pe dics and Traumatology, Gaetano Rummo Hos pi tal (Benevento, It aly), 156 pa tients with pertrochanteric frac ture, av er age age 82.7 years (75-102 years), were treated. In the an a lyzed case, there were 90 fe males and 66 males with pertrochanteric fractures. The re spon dents were di vided into two groups. The first group con sisted of 78 re spon dents who were treated with reamed intramedullary nails and the second group of 78 re spon dents treated with unreamed intramedullary nails. Dis cus sion. In fec tions are not the most com mon post op er a tive com pli ca tions. The risk of in fec tion is in creased in pa tients with comorbidity and in cases when there is an empty space be tween the intramedullary nail fix a tion and bone. Prox i mal fem o ral frac tures carry a high mor tality, but its causes are un clear. Con clu sion. Our research has shown that the ap pli ca tion of unreamed intramedullary nails in the treat ment of pertrochanteric fem o ral frac tures re duces a mor tal ity risk and risk of infection.

Aims A 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. Methods A 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: Bone Jt Open 2021;2(3):150–163.

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