{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T16:26:35Z","timestamp":1787415995292,"version":"build-2736575974"},"reference-count":48,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82274561"],"award-info":[{"award-number":["82274561"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Chinese Academy of Chinese Medical Sciences Wangjing Hospital","award":["WJYY-XZKT-2023-02"],"award-info":[{"award-number":["WJYY-XZKT-2023-02"]}]},{"name":"Nanyang Technology Breakthrough","award":["24KJGG268"],"award-info":[{"award-number":["24KJGG268"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Orthop Surg (Hong Kong)"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare the safety, clinical outcomes, and healthcare resource utilization associated with early versus delayed definitive fixation for acute pilon fractures through a systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Systematic review and meta-analysis. PubMed, Cochrane Library, Embase, Web of Science, CNKI, SinoMed, VIP Database, and Wanfang Data were searched. Eligibility criteria for study selection: Randomized controlled trials and comparative observational studies reporting early versus delayed definitive fixation in adult patients with pilon fractures were included. Data synthesis: The primary outcome was major soft-tissue complications. Secondary outcomes included minor soft-tissue complications, fracture union time, fracture healing complications, quality of reduction, ankle function, and length of hospital stay. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the I\n                      <jats:sup>2<\/jats:sup>\n                      , chi-square, and \u03c4\n                      <jats:sup>2<\/jats:sup>\n                      statistics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 21 studies involving 2,600 fractures were included. No significant difference was observed in major soft-tissue complications between early and delayed definitive fixation (OR,1.01 [95%CI, 0.57 to 1.79]). Early fixation was associated with a significantly shorter hospital stay (MD, -7.91 [95%CI,-10.71 to -5.10]). No significant differences were identified in minor soft-tissue complications, fracture healing complications, reduction quality, or ankle function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early definitive fixation for pilon fractures does not appear to increase the risk of soft-tissue complications when patients are carefully selected based on soft-tissue condition. Early intervention may reduce hospital stay and improve healthcare efficiency. These findings support an individualized, soft-tissue\u2013driven approach to surgical timing rather than arbitrary time thresholds in pilon fractures, although standardization of soft-tissue assessment criteria based on high-quality randomized trials remains necessary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10225536261480758","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:45:07Z","timestamp":1787226307000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing of open reduction and internal fixation for acute pilon fractures in adults: Early versus delayed \u2014 A systematic review and meta-analysis"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2415-1076","authenticated-orcid":false,"given":"Yang","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Evidence-Based Medicine Methodology Research, Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongzhong","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haibin","family":"Sun","sequence":"additional","affiliation":[{"name":"Nanyang Hospital of Traditional Chinese Medicine, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaolu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoyue","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Traumatology, Wangjing Hospital of China Academy of Chinese Medical Sciences, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.08.041"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-197908000-00007"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11751-015-0231-5"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-17-00160"},{"issue":"1","key":"e_1_3_6_6_2","first-page":"6","article-title":"The influence of the timing of surgery on soft tissue complications and hospital stay. 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