{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T11:33:54Z","timestamp":1774611234983,"version":"3.50.1"},"reference-count":25,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2015,7,27]]},"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The treatment of displaced, extra-articular fractures of the distal tibia remains controversial. These injuries are difficult to manage due to limited soft tissue cover, poor vascularity of the area and proximity to the ankle joint. Surgical treatment options are expanding and include locked intramedullary nails, plate and screw fixation and external fixator systems. The nail and plate options are most commonly used in the UK, but controversy exists over which treatment is most clinically and cost-effective. In this multicentre randomised controlled trial we aim to assess ratings of disability 6\u2005months postinjury in patients who have sustained a distal tibia fracture treated with either an intramedullary nail or plate and locking screw fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>Adult patients presenting at trial centres with an acute fracture of the distal tibia will be considered for inclusion. A total of 320 patients will provide 90% power to detect a difference of 8 points in Disability Rating Index (DRI) score at 6\u2005months at the 5% level. The randomisation sequence is stratified by trial centre and age, and administered via web-based service with 1:1 treatment allocation. Baseline demographic and pre-injury functional data and radiographs will be collected using the DRI, Olerud and Molander, and EuroQol EQ-5D questionnaire. Clinical assessment, early complications and radiographs will be recorded at 6\u20138\u2005weeks. Functional outcome, health-related quality of life and resource use will be collected at 3, 6 and 12\u2005months postoperatively. The main analysis will investigate differences in DRI 6\u2005months postsurgery, between the two treatment groups, on an intention-to-treat basis. Tests will be two-sided and considered to provide evidence for a significant difference if p values are &lt;0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>NRES Committee West-Midlands, 6\/11\/2012 (ref:12\/WM\/0340). The results of the trial will be disseminated via peer-reviewed publications and presentations at relevant conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ISRCTN99771224.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2015-009162","type":"journal-article","created":{"date-parts":[[2015,9,18]],"date-time":"2015-09-18T21:53:52Z","timestamp":1442613232000},"page":"e009162","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["UK Fixation of Distal Tibia Fractures (UK FixDT): protocol for a randomised controlled trial of \u2018locking\u2019 plate fixation versus intramedullary nail fixation in the treatment of adult patients with a displaced fracture of the distal tibia"],"prefix":"10.1136","volume":"5","author":[{"given":"Juul","family":"Achten","sequence":"first","affiliation":[{"name":"Warwick Medical School, The University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas R","family":"Parsons","sequence":"additional","affiliation":[{"name":"Warwick Medical School, The University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie R","family":"McGuinness","sequence":"additional","affiliation":[{"name":"Warwick Medical School, The University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stavros","family":"Petrou","sequence":"additional","affiliation":[{"name":"Warwick Medical School, The University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah E","family":"Lamb","sequence":"additional","affiliation":[{"name":"Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew L","family":"Costa","sequence":"additional","affiliation":[{"name":"Warwick Medical School, The University of Warwick, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,9,18]]},"reference":[{"key":"2025120619054289000_5.9.e009162.1","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1007\/s00264-002-0405-x","article-title":"Functional bracing in the treatment of delayed union and nonunion of the tibia","volume":"27","author":"Sarmiento","year":"2003","journal-title":"Int Orthop"},{"key":"2025120619054289000_5.9.e009162.2","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1097\/00005373-198411000-00007","article-title":"Infra-isthmal longitudinal fractures of the tibial diaphysis: results of treatment using closed intramedullary compression nailing","volume":"24","author":"Bostman","year":"1984","journal-title":"J Trauma"},{"key":"2025120619054289000_5.9.e009162.3","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(83)90094-3"},{"key":"2025120619054289000_5.9.e009162.4","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S0020-1383(00)00157-1","article-title":"Initial rotational stability of distal tibial fractures nailed without proximal locking: the importance of fracture type and degree of cortical contact","volume":"32","author":"Drosos","year":"2001","journal-title":"Injury"},{"key":"2025120619054289000_5.9.e009162.5","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(95)00116-6"},{"key":"2025120619054289000_5.9.e009162.6","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.3928\/0147-7447-20041101-15","article-title":"Comparison of intramedullary nailing of distal third tibial shaft fractures: before and after traumatologists","volume":"27","author":"Obremskey","year":"2004","journal-title":"Orthopedics"},{"key":"2025120619054289000_5.9.e009162.7","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/0020-1383(95)00150-6","article-title":"Unreamed intramedullary tibial nailing\u2013fatigue of locking bolts","volume":"27","author":"Boenisch","year":"1996","journal-title":"Injury"},{"key":"2025120619054289000_5.9.e009162.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(98)00213-7"},{"key":"2025120619054289000_5.9.e009162.9","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1097\/00003086-199307000-00013","article-title":"Open reduction and internal fixation of tibial plafond fractures. 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