ACTIVE (Scotland application)
Research type
Research Study
Full title
External frame versus internal locking plate for articular pilon fracture fixation: a multi-centre randomised controlled trial
IRAS ID
250857
Contact name
Hemant Sharma
Contact email
Sponsor organisation
Hull & East Yorkshire Hospitals NHS Trust
ISRCTN Number
ISRCTN98152560
Clinicaltrials.gov Identifier
R2177, Sponsor's Reference Number; 104856, EDGE system reference number
Duration of Study in the UK
4 years, 11 months, 31 days
Research summary
BACKGROUND
A pilon fracture is a severe break of the shin bone where it forms the ankle joint. It is usually caused by high-energy impact such as a fall from a height. These injuries are very difficult to treat, and can have a very large negative effect on a person’s quality of life. Surgery is needed to fix the broken bone, which can lead to serious infections, meaning more treatment is needed, including on occasion amputation. Even where the fracture heals well, most patients develop arthritis in the joint.The injury is usually fixed by orthopaedic surgeons from the inside (under the skin) using a plate and screws (called 'internal fixation') or fixed from the outside using a ring frame or cage ('external fixation'). The internal plate is cheaper than the external ring but the internal plate may increase the chance of the patient getting a deep infection. There is genuine uncertainty among surgeons as to which is the preferred surgical option. National Institute for Health and Care Excellence and Consultant Orthopaedic Surgeons have recommended that high-quality research is needed to find out whether internal or external fixation is best for treating pilon fractures and better use of NHS money.
METHODS
This study aims to investigate the clinical and cost-effectiveness of internal plate fixation versus external fine wire fixation for the management of Type C pilon fractures.A randomised controlled trial will compare the outcomes of patients who receive internal plate or external fixation at 3, 6, 12 and 24 months follow-up. A qualitative study will explore recruitment issues.
All adult patients (16 years or older) with a closed type C pilon fracture of the tibia will be included where the treating surgeon believes the patient will benefit from surgical fixation.
The study will take place in NHS hospitals in England, Scotland and Wales.
REC name
Scotland A: Adults with Incapacity only
REC reference
19/SS/0003
Date of REC Opinion
24 Jan 2019
REC opinion
Unfavourable Opinion