{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:56:06Z","timestamp":1790805366978,"version":"4.1.0"},"reference-count":12,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>To evaluate the effect of joint preparation and patient factors on outcomes and complications in patients treated acutely with hindfoot fusion nails for ankle and pilon fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Retrospective chart review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Thirteen US trauma centers and 2 UK trauma centers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient Selection Criteria:<\/jats:title>\n                    <jats:p>Ankle and pilon fractures (AO-OTA types A-C) from 2010 to 2020 acutely treated definitively with hindfoot fusion nail were reviewed. Patients at least 18 years old and with minimum 6 months follow-up or earlier diagnosis of complication were included. Exclusion criteria included nonambulatory at baseline, prior internal fixation that failed and underwent revision, and prior tibiotalar or subtalar arthrodesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome Measurements and Comparisons:<\/jats:title>\n                    <jats:p>The primary outcome was final postoperative ambulatory status. Secondary outcomes were infectious and fracture-related complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      One hundred forty-nine patients (75 men; 74 women; age 20\u201399; median 63 years) were treated for ankle (104) or pilon (45; 8A, 13B, 24C) fractures. Eighty-five patients (44%) had open fractures and 55 (37%) had diabetes. Thirty-six patients (24%) had joint preparation at the time of surgery. Forty-five (30%) were made weight bearing as tolerated postoperatively; the median time to mobilize was 1.5 days (0\u2013210) and to full weight bearing was 35 days (0\u20131462). Fifty-seven patients (85%) returned to their preinjury ambulatory status, which was not affected by joint preparation (50% vs. 59%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.327). Joint preparation led to higher articular fusion rates (94% vs. 24%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001) and fewer hardware removals (19% vs. 42%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.013), but trended toward a higher fracture nonunion rate (19% vs. 8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.053). Forty-five patients (30%) had infectious complications, 60 (40%) had a fracture-related complication, and 67 (45%) had additional procedures. Open fractures did not lead to any differences in superficial or deep infection. Insulin-dependent diabetes was associated with higher rates of infectious complications (31% vs. 15%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.028) and amputation (17% vs. 4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.029).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>\n                      Hindfoot fusion nails for acute ankle and pilon injuries had high complication rates. More complications occurred in patients with insulin-dependent diabetes. While 95% regained ambulation, only 57% returned to preoperative status. Joint preparation led to higher rates of articular fusion (94% vs. 24%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) but not fracture union (81% vs. 66%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.106).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LEVEL OF EVIDENCE:<\/jats:title>\n                    <jats:p>Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000003104","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T14:08:19Z","timestamp":1770991699000},"page":"148-154","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Factors Affecting Outcomes of Hindfoot Fusion Nails for Acute Injury: A Multicenter Study"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7618-6719","authenticated-orcid":false,"given":"Eugene","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6448-8864","authenticated-orcid":false,"given":"Paul","family":"Tornetta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Boston Medical Center, Boston, MA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon B.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Louisville, Louisville, KY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Schultz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Louisville, Louisville, KY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrett","family":"Wireman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Louisville, Louisville, KY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Ollivere","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Orthopaedics and Sports Medicine, Dermatology, University of Nottingham, Queens Medical Centre, Nottingham, UK;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Zheng","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Orthopaedics and Sports Medicine, Dermatology, University of Nottingham, Queens Medical Centre, Nottingham, UK;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clay","family":"Spitler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Patch","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"White","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Heinz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Stinner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Vanderbilt, Nashville, TN;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline Elizabeth","family":"Lahurd","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Vanderbilt, Nashville, TN;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Ostrum","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Baumann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Kottmeier","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stony Brook University Health Sciences Center, Stony Brook, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Doany","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stony Brook University Health Sciences Center, Stony Brook, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Krause","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Redlich","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Egol","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjit","family":"Konda","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassan","family":"Mir","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of South Florida, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"McCaskey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of South Florida, Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, FL;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil","family":"Azer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Upstate Medical University, East Syracuse, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jace","family":"Kusler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, SUNY Upstate Medical University, East Syracuse, NY;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Beltran","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendall","family":"Masada","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystin A.","family":"Hidden","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Kuttner","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20260213","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.injury.2016.11.017","article-title":"Fragility fractures of the ankle in the elderly: open reduction and internal fixation versus tibio-talo-calcaneal nailing: short-term results of a prospective randomized-controlled study","volume":"48","author":"Georgiannos","year":"2017","journal-title":"Injury"},{"key":"R2-20260213","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.injury.2012.11.008","article-title":"Functional outcome following tibio-talar-calcaneal nailing for unstable osteoporotic ankle 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