{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T14:22:50Z","timestamp":1793283770732,"version":"4.5.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002352","name":"Ain Shams University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare functional and radiological outcomes between two stage ORIF and single stage external fixation for complex pilon fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective, single-center randomized controlled trial at a Level I trauma facility (April 2021\u2013April 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All 60 patients completed follow-up. Compared with LIFEF, two-stage ORIF achieved higher AOFAS scores (85\u2009\u00b1\u20099 vs. 77\u2009\u00b1\u200910;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006), earlier return to work (7\u2009\u00b1\u20091.5 vs. 10\u2009\u00b1\u20093 months;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001), and shorter time to union (17\u2009\u00b1\u20093.6 vs. 19\u2009\u00b1\u20093.5 weeks;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02). Groups did not differ in quality of reduction (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.14), ankle ROM (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.10 and 0.058 for dorsiflexion and plantarflexion), FRI (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.69), PTOA (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.64), or bone-healing complications (nonunion, delayed union, malunion;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.24, 0.39, 0.39).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Two-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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registry<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrials.gov\" ext-link-type=\"uri\">ClinicalTrials.gov<\/jats:ext-link>\n                      , NCT05141227, Registration date: 29 July 2021.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-025-06682-2","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T03:15:35Z","timestamp":1763003735000},"page":"287-293","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of two-stage open reduction and internal fixation and single-stage external fixation for complex pilon fractures: a randomized controlled trial"],"prefix":"10.1007","volume":"50","author":[{"given":"Mohamed Osama","family":"Eissa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mootaz Fouad","family":"Thakeb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salah","family":"AbouSeif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamer A.","family":"Fayyad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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