{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T07:01:05Z","timestamp":1785394865496,"version":"3.55.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008247","name":"University of Otago","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008247","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Musculoskelet Surg"],"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n To compare outcomes between planned and delayed ex-fix and identify predictors for requiring external fixation for closed ankle fractures.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Design:<\/jats:italic>\n Retrospective case\u2013control study.\n <\/jats:p>\n \n Setting:<\/jats:italic>\n Single trauma centre.\n <\/jats:p>\n \n Patient selection criteria:<\/jats:italic>\n Skeletally mature patients with closed ankle fractures, with or without dislocation, temporised in cast or external fixation (ex-fix) (<\u200924 versus\u2009>\u200924\u00a0h), treated with open reduction\/internal fixation.\n <\/jats:p>\n Outcome Measures and Comparisons: Planned (\u2264\u200924\u00a0h from admission) or delayed (>\u200924\u00a0h) patients were compared in terms of time to definitive fixation, length of stay (LOS), and complications. A control cohort of cast-only patients with identical AO\/OTA fracture patterns was identified to evaluate predictors of requiring ex-fix. Initial radiographs were analysed for talar displacement, posterior malleolar fragment (PMF) size, and number of reduction attempts.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Seventy-one patients underwent external fixation (25 planned, 46 delayed). Planned ex-fix was associated with significantly shorter time from admission to definitive fixation (7.8 vs 11.7\u00a0days,\n p<\/jats:italic>\n \u2009<\u20090.0001) and reduced LOS (11.2 vs 16.6\u00a0days,\n p<\/jats:italic>\n \u2009=\u20090.0037) compared with delayed ex-fix. Complication rates did not differ significantly between groups. Compared with controls, patients requiring delayed ex-fix demonstrated greater talar displacement on AP and lateral radiographs (\n p<\/jats:italic>\n \u2009=\u20090.02 and\n p<\/jats:italic>\n \u2009=\u20090.001, respectively). A PMF size\u2009\u2265\u200923% (OR 5.74,\n p<\/jats:italic>\n \u2009=\u20090.0002) and two or more reduction attempts (OR 4.68,\n p<\/jats:italic>\n \u2009=\u20090.0022) were independently associated with the need for external fixation.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Planned external fixation in closed ankle fractures is associated with shorter hospital stay and earlier definitive fixation compared with delayed application. Significant talar displacement, larger posterior malleolar fragments, and multiple failed reduction attempts may help identify fractures that would benefit from planned external fixation.<\/jats:p>\n <\/jats:sec>\n \n Level of evidence:<\/jats:title>\n Therapeutic and Diagnostic Level III<\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s12306-026-00966-5","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:38:28Z","timestamp":1785393508000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predicting need for and effect of external fixation in closed ankle fractures: a retrospective case\u2013control study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7844-6481","authenticated-orcid":false,"given":"J.","family":"Lynch-Larkin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Powell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Ingoe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Sharr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"issue":"1","key":"966_CR1","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1186\/s12891-018-2326-x","volume":"19","author":"H Juto","year":"2018","unstructured":"Juto H, Nilsson H, Morberg P (2018) Epidemiology of adult ankle fractures: 1756 cases identified in Norrbotten County during 2009\u20132013 and classified according to AO\/OTA. BMC Musculoskelet Disord 19(1):441. https:\/\/doi.org\/10.1186\/s12891-018-2326-x","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"966_CR2","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.fas.2016.11.002","volume":"24","author":"R Elsoe","year":"2018","unstructured":"Elsoe R, Ostgaard SE, Larsen P (2018) Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg 24(1):34\u201339. https:\/\/doi.org\/10.1016\/j.fas.2016.11.002","journal-title":"Foot Ankle Surg"},{"issue":"Supplement 1","key":"966_CR3","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1097\/BOT.0000000000001063","volume":"32","author":"EG Meinberg","year":"2018","unstructured":"Meinberg EG, Agel J, Roberts CS et al (2018) Fracture and dislocation classification compendium - 2018. J Orthop Trauma 32(Supplement 1):S1\u2013S170","journal-title":"J Orthop Trauma"},{"key":"966_CR4","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1177\/1071100719879431","volume":"41","author":"RA Wawrose","year":"2020","unstructured":"Wawrose RA, Grossman LS, Tagliaferro M et al (2020) Temporizing external fixation vs splinting following ankle fracture dislocation. Foot Ankle Int 41:177\u2013182. https:\/\/doi.org\/10.1177\/1071100719879431","journal-title":"Foot Ankle Int"},{"key":"966_CR5","first-page":"1008","volume":"1","author":"A Matson","year":"2017","unstructured":"Matson A, Zura R, Green C et al (2017) Observations on closed reduction of ankle fracture- dislocations with subsequent operative treatment: predicting the need for early operative intervention based on clinical features of reduction. Foot Ankle Stud 1:1008","journal-title":"Foot Ankle Stud"},{"issue":"6","key":"966_CR6","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1177\/10711007211070540","volume":"43","author":"K Pilskog","year":"2022","unstructured":"Pilskog K, Gote TB, Odland HEJ et al (2022) Association of delayed surgery for ankle fractures and patient-reported outcomes. Foot Ankle Int 43(6):762\u2013771. https:\/\/doi.org\/10.1177\/10711007211070540","journal-title":"Foot Ankle Int"},{"key":"966_CR7","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1186\/s12891-022-05646-6","volume":"23","author":"R Gerlach","year":"2022","unstructured":"Gerlach R, Toepfer A, Jacxsens M et al (2022) Temporizing cast immobilization is a safe alternative to external fixation in ankle fracture-dislocation while posterior malleolar fragment size predicts loss of reduction: a case control study. BMC Musculoskelet Disord 23:698. https:\/\/doi.org\/10.1186\/s12891-022-05646-6","journal-title":"BMC Musculoskelet Disord"},{"key":"966_CR8","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.fas.2021.03.018","volume":"28","author":"MO Buyukkuscu","year":"2022","unstructured":"Buyukkuscu MO, Basilgan S, Mollaomeroglu A et al (2022) Splinting vs temporary external fixation in the initial treatment of ankle fracture-dislocations. Foot Ankle Surg 28:235\u2013239. https:\/\/doi.org\/10.1016\/j.fas.2021.03.018","journal-title":"Foot Ankle Surg"}],"container-title":["MUSCULOSKELETAL SURGERY"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-026-00966-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12306-026-00966-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12306-026-00966-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:38:29Z","timestamp":1785393509000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12306-026-00966-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":8,"alternative-id":["966"],"URL":"https:\/\/doi.org\/10.1007\/s12306-026-00966-5","relation":{},"ISSN":["2035-5114"],"issn-type":[{"value":"2035-5114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]},"assertion":[{"value":"22 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}