{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:49:12Z","timestamp":1791438552669,"version":"4.3.3"},"reference-count":21,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot Ankle Int."],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>AO\/OTA 43C pilon fractures are severe intra-articular distal tibia injuries associated with high complication rates. Although open reduction internal fixation (ORIF) remains the standard treatment, tibiotalocalcaneal (TTC) nailing has been used in select patients; this study compared characteristics and outcomes of patients treated with ORIF or TTC nailing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A retrospective cohort study was performed of adult patients (\u226518\u2009years) with AO\/OTA 43C pilon fractures and \u226590\u2009days of follow-up treated operatively at a single level 1 trauma center between 2020 and 2025. Patients treated with TTC nailing were matched 1:1 to patients treated with ORIF based on open vs closed fracture status, with open fractures further matched by Gustilo-Anderson classification. Primary outcomes included fracture-related infection (FRI), reoperation, fracture nonunion, amputation, and hospital length of stay (LOS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In the unmatched cohort (n\u2009=\u2009436), TTC patients had higher rates of open fractures (58.6% vs 38.8%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.002), higher Injury Severity Scores (ISSs) (15.8 vs 11.3,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.001), and higher rates of polytrauma (42.9% vs 22.4%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). TTC nailing was associated with higher rates of FRI (25.7% vs 13.7%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.011), longer hospital LOS (13.0 vs 9.4\u2009days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.004), and more frequent intensive care unit (ICU) admission (31.4% vs 20.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.038). After matching, the cohort included 70 TTC and 70 ORIF patients. TTC patients continued to have higher ISS (15.8 vs 11.4,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.009), higher polytrauma rates (42.9% vs 20.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.004), more blood transfusions (48.6% vs 17.1%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001), and more frequent ICU admission (31.4% vs 17.1%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.049). However, rates of FRI, reoperation, fracture nonunion, and amputation were similar between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>With the numbers available, rates of postoperative complications showed no significant difference that could be detected between TTC nailing and ORIF after matching, supporting its use as a viable limb salvage strategy in patients with pilon fractures characterized by severe articular comminution, poor bone quality, or compromised soft tissues limiting conventional reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level III, retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10711007261481165","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T12:18:21Z","timestamp":1789561101000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of AO\/OTA 43C Pilon Fractures Treated With Open Reduction Internal Fixation or Tibiotalocalcaneal Nailing"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-9447-2857","authenticated-orcid":false,"given":"Robin M.","family":"Litten","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Turner","family":"Sankey","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandler S.","family":"Harris","sequence":"additional","affiliation":[{"name":"Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan N.","family":"McIlwain","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clay A.","family":"Spitler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joey P.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3205-755X","authenticated-orcid":false,"given":"Michael D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"105","article-title":"The operative treatment of intra-articular fractures of the lower end of the tibia","volume":"138","author":"R\u00fcedi TP","year":"1979","unstructured":"R\u00fcedi TP, Allg\u00f6wer M. The operative treatment of intra-articular fractures of the lower end of the tibia. Clin Orthop Relat Res. 1979;138:105-110.","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0020-1383(73)80089-0"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.77B3.7744927"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-199206000-00011"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200007000-00006"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-201110000-00005"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-199902000-00002"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.764232"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/107110070602700406"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.08.041"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/2473011418780437"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000002096"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/bot.0000000000003104"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2018.07.028"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2025.112177"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0000000000000404"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-198704000-00005"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.08.040"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2017.04.020"},{"key":"e_1_3_2_21_2","article-title":"Concepts of fracture union, delayed union, and nonunion","volume":"355","author":"Marsh D","year":"1998","unstructured":"Marsh D. Concepts of fracture union, delayed union, and nonunion. Clin Orthop Relat Res. 1998;355:S22-S30.","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.201.09.008"}],"container-title":["Foot &amp; Ankle International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10711007261481165","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10711007261481165","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10711007261481165","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:49:22Z","timestamp":1791434962000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10711007261481165"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":21,"alternative-id":["10.1177\/10711007261481165"],"URL":"https:\/\/doi.org\/10.1177\/10711007261481165","relation":{},"ISSN":["1071-1007","1944-7876"],"issn-type":[{"value":"1071-1007","type":"print"},{"value":"1944-7876","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"10711007261481165"}}