{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T23:41:41Z","timestamp":1779147701818,"version":"3.51.4"},"reference-count":24,"publisher":"Royal College of Surgeons of England","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p> Pilon fractures are potentially limb-threating injuries. Staged soft tissue damage control is described, but actual practices are unknown. We report a national trainee collaborative evaluating how tibial Pilon fractures are acutely managed. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> ENFORCE was a multicentre retrospective observational study of the acute management of tibial Pilon fractures over a three-year period. Mechanism of injury, imaging, fracture classification, time to cast application, soft tissue damage control strategy and definitive management details were determined. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> A total of 656 patients (670 fractures) across 27 centres were reported. AO fracture classifications were: partial articular (n=294) and complete articular (n=376). Initial diagnostic imaging mobilities were plain radiographs (n=602) and a trauma computed tomography (CT) scan (n=54). A total of 526 fractures had a cast applied in the emergency department (91 before radiological diagnosis), with the times taken to obtain postcast imaging being: mean 2.7 hours, median 2.3 hours and range 28 minutes\u201314 hours. 35% (102\/294) of partial articular and 57% (216\/376) of complete articular fractures had a spanning external fixator applied, all of which underwent a planning CT scan. Definitive management consisted of open reduction internal fixation (n=495), fine wire frame (n=86), spanning external fixator (n=25), intramedullary nail (n=25) or other (n=18). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> The management of tibial Pilon fractures is variable, with just over half of complete articular fractures managed with the gold standard \u2018span, scan, plan\u2019 staged soft tissue resuscitation. A national standard of care would increase the profile and standardise management of these potentially limb-threatening injuries, together with setting them apart from more straightforward ankle fractures. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2024.0063","type":"journal-article","created":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T12:04:03Z","timestamp":1734091443000},"page":"268-274","source":"Crossref","is-referenced-by-count":3,"title":["The acute management of Pilon fractures (ENFORCE) study: a national evaluation of practice"],"prefix":"10.1308","volume":"107","author":[{"given":"DS","family":"Hill","sequence":"first","affiliation":[{"name":"Torbay and South Devon NHS Foundation Trust","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JR","family":"Davis","sequence":"additional","affiliation":[{"name":"Torbay and South Devon NHS Foundation Trust","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"ENFORCE Collaborative","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"171","reference":[{"key":"C1","doi-asserted-by":"publisher","DOI":"10.1302\/2058-5241.1.000016"},{"key":"C2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.04.130"},{"key":"C3","doi-asserted-by":"publisher","DOI":"10.1302\/2633-1462.23.BJO-2020-0178"},{"key":"C4","doi-asserted-by":"publisher","DOI":"10.1308\/rcsann.2023.0049"},{"key":"C5","unstructured":"Orthopaedic Trauma Association (OTA). 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