{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T22:32:46Z","timestamp":1787697166182,"version":"build-2784847793"},"reference-count":43,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,11,22]]},"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Ankle fractures are common in the elderly population. Surgical fixation is technically challenging and often results in complications due to high rates of osteoporosis and vascular disease. Open reduction and internal fixation (ORIF) often requires prolonged periods of non-weight bearing increasing the risks of complications. Tibiotalocalcaneal (TTC) nailing has been suggested as an alternative to ORIF which allows immediate weight bearing, and is suggested to result in fewer complications. This study aims to compare the two surgical techniques in the elderly population with ankle fractures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>The study will be a multicentre, prospective, randomised controlled trial comparing ORIF to TTC nailing in 110 patients with ankle fractures aged 50 or above with a Charlson Comorbidity Index of greater than or equal to four. Participants and assessors will not be blinded to intervention. The primary outcome measure will be overall complication rate. Secondary outcomes include length of hospital stay, mobility at discharge, discharge destination, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, the Olerud-Molander Ankle Score, mortality rate, rate of secondary surgical interventions and number of blood transfusions required postoperatively. Our null hypothesis is that there is no clinically significant difference in the primary outcome measure between the two treatment groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>The study has been approved by Metro South Hospital and Health Services Human Research Ethics Committee (EC00167) (reference number HREC\/17\/QPAH\/351).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Completion of this trial will provide evidence on the effectiveness of TTC nailing versus ORIF in treatment of the elderly ankle fracture. If TTC nailing is found to result in superior outcomes, this trial has the capacity to change current clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p>ACTRN12617001588381;Pre-results andU1111-1203-1704.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026360","type":"journal-article","created":{"date-parts":[[2019,1,22]],"date-time":"2019-01-22T18:09:15Z","timestamp":1548180555000},"page":"e026360","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Transarticular tibiotalocalcaneal nailing versus open reduction and internal fixation for treatment of the elderly ankle fracture: protocol for a multicentre, prospective, randomised controlled trial"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-8492","authenticated-orcid":false,"given":"Paul","family":"Tuckett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Hope","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Tetsworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Van De Pol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"McDougall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,1,21]]},"reference":[{"key":"2024052011154286000_9.1.e026360.1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.83B4.11522"},{"key":"2024052011154286000_9.1.e026360.2","doi-asserted-by":"publisher","DOI":"10.3109\/17453679809002355"},{"key":"2024052011154286000_9.1.e026360.3","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200604000-00006"},{"key":"2024052011154286000_9.1.e026360.4","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.amsu.2015.12.061","article-title":"Clinical audit of ankle fracture management in the elderly","volume":"6","author":"Kurar","year":"2016","journal-title":"Ann Med Surg"},{"key":"2024052011154286000_9.1.e026360.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-014-2140-3"},{"key":"2024052011154286000_9.1.e026360.6","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.O.00095"},{"key":"2024052011154286000_9.1.e026360.7","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1053\/j.jfas.2014.10.015","article-title":"Are low-energy open ankle fractures in the elderly the new geriatric hip fracture?","volume":"54","author":"Toole","year":"2015","journal-title":"J Foot Ankle Surg"},{"key":"2024052011154286000_9.1.e026360.8","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.injury.2016.11.014","article-title":"Low energy open ankle fractures in the elderly: Outcome and treatment algorithm","volume":"48","author":"Wijendra","year":"2017","journal-title":"Injury"},{"key":"2024052011154286000_9.1.e026360.9","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(02)00832-3"},{"key":"2024052011154286000_9.1.e026360.10","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2012.672091"},{"key":"2024052011154286000_9.1.e026360.11","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s13670-017-0196-y","article-title":"Management of Osteoporotic and Neuropathic Ankle Fractures in the Elderly","volume":"6","author":"Hoogervorst","year":"2017","journal-title":"Curr Geriatr Rep"},{"issue":"Suppl 3","key":"2024052011154286000_9.1.e026360.12","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.injury.2007.08.005","article-title":"The management of ankle fractures in the elderly","volume":"38","author":"Strauss","year":"2007","journal-title":"Injury"},{"key":"2024052011154286000_9.1.e026360.13","doi-asserted-by":"publisher","DOI":"10.3310\/hta20220"},{"issue":"Suppl 3","key":"2024052011154286000_9.1.e026360.14","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/S0020-1383(13)70192-X","article-title":"Operative management of unstable ankle fractures in the elderly: our institutional experience","volume":"44","author":"Ehrenfreund","year":"2013","journal-title":"Injury"},{"key":"2024052011154286000_9.1.e026360.15","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(93)90202-H"},{"key":"2024052011154286000_9.1.e026360.16","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-198701040-00002"},{"key":"2024052011154286000_9.1.e026360.17","doi-asserted-by":"publisher","DOI":"10.1177\/1071100715573707"},{"key":"2024052011154286000_9.1.e026360.18","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198567010-00010"},{"key":"2024052011154286000_9.1.e026360.19","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1302\/0301-620X.96B6.32721","article-title":"Fragility fractures of the ankle in the frail elderly patient: treatment with a long calcaneotalotibial nail","volume":"96-B","author":"Al-Nammari","year":"2014","journal-title":"Bone Joint J"},{"key":"2024052011154286000_9.1.e026360.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2013.01.010"},{"key":"2024052011154286000_9.1.e026360.21","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-008-0584-z"},{"key":"2024052011154286000_9.1.e026360.22","first-page":"1440","article-title":"Complications of immobilization and bed rest. Part 2: Other complications","volume":"39","author":"Teasell","year":"1993","journal-title":"Can Fam Physician"},{"key":"2024052011154286000_9.1.e026360.23","doi-asserted-by":"crossref","unstructured":"Prandoni P . Acquired risk factors for venous thromboembolism in medical patients. Hematology Am Soc Hematol Educ Program 2005:458\u201361.doi:10.1182\/asheducation-2005.1.458","DOI":"10.1182\/asheducation-2005.1.458"},{"key":"2024052011154286000_9.1.e026360.24","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(01)00034-1"},{"key":"2024052011154286000_9.1.e026360.25","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1046\/j.1460-9584.2000.00213.x","article-title":"Outcome of ankle fractures in the elderly","volume":"6","author":"Buckingham","year":"2000","journal-title":"Foot and Ankle Surgery"},{"key":"2024052011154286000_9.1.e026360.26","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1302\/0301-620X.87B6.16146","article-title":"Fragility fractures of the ankle: stabilisation with an expandable calcaneotalotibial nail","volume":"87","author":"Lemon","year":"2005","journal-title":"J Bone Joint Surg Br"},{"key":"2024052011154286000_9.1.e026360.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2012.11.008"},{"key":"2024052011154286000_9.1.e026360.28","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":"2024052011154286000_9.1.e026360.29","first-page":"506","article-title":"SPIRIT 2013 Statement: defining standard protocol items for clinical trials","volume":"38","author":"Chan","year":"2015","journal-title":"Rev Panam Salud Publica"},{"key":"2024052011154286000_9.1.e026360.30","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"2024052011154286000_9.1.e026360.31","doi-asserted-by":"crossref","first-page":"47","DOI":"10.7812\/TPP\/15-065","article-title":"Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization","volume":"20","author":"Yian","year":"2016","journal-title":"Perm J"},{"key":"2024052011154286000_9.1.e026360.32","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.arth.2016.11.014","article-title":"Higher Modified Charlson Index Scores Are Associated With Increased Incidence of Complications, Transfusion Events, and Length of Stay Following Revision Hip Arthroplasty","volume":"32","author":"Lakomkin","year":"2017","journal-title":"J Arthroplasty"},{"issue":"Suppl 1","key":"2024052011154286000_9.1.e026360.33","first-page":"S65","article-title":"Malleolar segment","volume":"32","author":"Anon","year":"2018","journal-title":"J Orthop Trauma"},{"issue":"4 Suppl","key":"2024052011154286000_9.1.e026360.34","doi-asserted-by":"crossref","first-page":"S245","DOI":"10.1016\/j.otsr.2016.03.004","article-title":"Analysis of risk factors of the postoperative complications of surgical treatment of ankle fractures in the elderly: A series of 477\u00a0patients","volume":"102","author":"Varenne","year":"2016","journal-title":"Orthop Traumatol Surg Res"},{"key":"2024052011154286000_9.1.e026360.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0895-4356(98)00138-3"},{"key":"2024052011154286000_9.1.e026360.36","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-20-05-273"},{"key":"2024052011154286000_9.1.e026360.37","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/107110079401500701","article-title":"Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes","volume":"15","author":"Kitaoka","year":"1994","journal-title":"Foot Ankle Int"},{"key":"2024052011154286000_9.1.e026360.38","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2006.12.002"},{"key":"2024052011154286000_9.1.e026360.39","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.gaitpost.2009.10.012","article-title":"One year follow-up after operative ankle fractures: a prospective gait analysis study with a multi-segment foot model","volume":"31","author":"Wang","year":"2010","journal-title":"Gait Posture"},{"key":"2024052011154286000_9.1.e026360.40","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-14-109"},{"key":"2024052011154286000_9.1.e026360.41","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1097\/j.pain.0000000000000954","article-title":"Validation of EQ-5D and 15D in the assessment of health-related quality of life in chronic pain","volume":"158","author":"Vartiainen","year":"2017","journal-title":"Pain"},{"key":"2024052011154286000_9.1.e026360.42","doi-asserted-by":"publisher","DOI":"10.3109\/07853890109002087"},{"key":"2024052011154286000_9.1.e026360.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2011.09.004"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2018-026360","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T18:24:45Z","timestamp":1716229485000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2018-026360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1,21]]},"published-print":{"date-parts":[[2019,1]]}},"alternative-id":["10.1136\/bmjopen-2018-026360"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2018-026360","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1]]}}}