Abstract：
To assess the complication rate of hindfoot nailing of acute fractures involving the tibiotalar joint, and mortality, patient-reported outcome measures, and return to preinjury activities.
MEDLINE; EMBASE.
A systematic literature search for articles in English was completed using MEDLINE and EMBASE databases on April 23, 2020. Original research articles that assessed patients with acute intra-articular fractures of the ankle joint (malleolar ankle fractures and/or pilon fractures) that were treated with a locked hindfoot intramedullary nail, inserted retrograde through the plantar surface of the foot, were selected for inclusion. Case reports (≤4 patients), studies with nonlocked implants, and non-English studies were excluded.
A validated data extraction form was used, which included study demographics (authors, journal, date of publication, and study design), patient characteristics, implant type, and reported outcomes. Risk of bias for each included study was evaluated using the Institute of Health Economics Quality Appraisal Checklist for case series and the Risk of Bias in randomized trials tool, where appropriate. The best evidence was summarized and weighted mean values were provided when appropriate.
Ten case series and one randomized controlled trial were included. The overall quality of studies was poor with considerable bias. The majority of studies included elderly patients (weighted mean age 75.5 years) with diabetes (42% of patients). Overall complication rate was 16% with an 8% major complication rate (deep infection, malunion, nonunion, implant failure) and an overall infection rate of 6.2%. Pooled mortality rate was 27% with fracture union rates from 88% to 100%. Mean proportion of patients able to return to preinjury level of activity was 85%.
Hindfoot nailing of acute ankle and pilon fractures in elderly patients and patients with diabetes is associated with complication rates comparable with other methods of fixation. Issues with elimination of subtalar joint motion and implant complications secondary to poor implant fixation persist. The literature to date has composed of primarily Level IV studies with considerable bias. Further research is necessary to clarify the role of hindfoot nailing of acute ankle and pilon fractures.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
MEDLINE; EMBASE.
A systematic literature search for articles in English was completed using MEDLINE and EMBASE databases on April 23, 2020. Original research articles that assessed patients with acute intra-articular fractures of the ankle joint (malleolar ankle fractures and/or pilon fractures) that were treated with a locked hindfoot intramedullary nail, inserted retrograde through the plantar surface of the foot, were selected for inclusion. Case reports (≤4 patients), studies with nonlocked implants, and non-English studies were excluded.
A validated data extraction form was used, which included study demographics (authors, journal, date of publication, and study design), patient characteristics, implant type, and reported outcomes. Risk of bias for each included study was evaluated using the Institute of Health Economics Quality Appraisal Checklist for case series and the Risk of Bias in randomized trials tool, where appropriate. The best evidence was summarized and weighted mean values were provided when appropriate.
Ten case series and one randomized controlled trial were included. The overall quality of studies was poor with considerable bias. The majority of studies included elderly patients (weighted mean age 75.5 years) with diabetes (42% of patients). Overall complication rate was 16% with an 8% major complication rate (deep infection, malunion, nonunion, implant failure) and an overall infection rate of 6.2%. Pooled mortality rate was 27% with fracture union rates from 88% to 100%. Mean proportion of patients able to return to preinjury level of activity was 85%.
Hindfoot nailing of acute ankle and pilon fractures in elderly patients and patients with diabetes is associated with complication rates comparable with other methods of fixation. Issues with elimination of subtalar joint motion and implant complications secondary to poor implant fixation persist. The literature to date has composed of primarily Level IV studies with considerable bias. Further research is necessary to clarify the role of hindfoot nailing of acute ankle and pilon fractures.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
摘要：
评估累及胫骨关节的急性骨折后足钉内固定的并发症发生率。和死亡率，患者报告的结果指标，并恢复受伤前的活动。
MEDLINE；EMBASE。
2020年4月23日，使用MEDLINE和EMBASE数据库完成了对英文文章的系统文献检索。原始的研究文章，评估患者的急性关节内骨折踝关节（踝关节骨折和/或pilon骨折）与锁定后足髓内钉治疗，通过足的足底表面逆行插入，被选中列入名单。病例报告（≤4名患者），非锁定植入物的研究，非英语学习被排除在外。
使用了经过验证的数据提取表，其中包括研究人口统计学(作者，journal,发布日期,和研究设计)，患者特征,植入物类型,并报告结果。使用卫生经济学研究所的病例系列质量评估清单和随机试验工具中的偏倚风险评估每个纳入研究的偏倚风险。在适当的地方。总结了最佳证据，并在适当时提供了加权平均值。
纳入10个病例系列和1个随机对照试验。研究的总体质量较差，存在相当大的偏倚。大多数研究包括老年糖尿病患者（加权平均年龄75.5岁）（42％的患者）。总并发症发生率为16%，主要并发症发生率为8%（深部感染，malunion,骨不连,植入物失败）和总体感染率为6.2％。合并死亡率为27％，骨折愈合率为88％至100％。能够恢复到损伤前活动水平的患者的平均比例为85％。
老年患者和糖尿病患者急性踝关节和Pilon骨折的足后钉与其他固定方法的并发症发生率相当。由于植入物固定不良而消除距下关节运动和植入物并发症的问题仍然存在。迄今为止的文献主要由IV级研究组成，有相当大的偏见。需要进一步研究以阐明后足钉在急性踝关节和Pilon骨折中的作用。
治疗级别IV。有关证据级别的完整描述，请参阅作者说明。
MEDLINE；EMBASE。
2020年4月23日，使用MEDLINE和EMBASE数据库完成了对英文文章的系统文献检索。原始的研究文章，评估患者的急性关节内骨折踝关节（踝关节骨折和/或pilon骨折）与锁定后足髓内钉治疗，通过足的足底表面逆行插入，被选中列入名单。病例报告（≤4名患者），非锁定植入物的研究，非英语学习被排除在外。
使用了经过验证的数据提取表，其中包括研究人口统计学(作者，journal,发布日期,和研究设计)，患者特征,植入物类型,并报告结果。使用卫生经济学研究所的病例系列质量评估清单和随机试验工具中的偏倚风险评估每个纳入研究的偏倚风险。在适当的地方。总结了最佳证据，并在适当时提供了加权平均值。
纳入10个病例系列和1个随机对照试验。研究的总体质量较差，存在相当大的偏倚。大多数研究包括老年糖尿病患者（加权平均年龄75.5岁）（42％的患者）。总并发症发生率为16%，主要并发症发生率为8%（深部感染，malunion,骨不连,植入物失败）和总体感染率为6.2％。合并死亡率为27％，骨折愈合率为88％至100％。能够恢复到损伤前活动水平的患者的平均比例为85％。
老年患者和糖尿病患者急性踝关节和Pilon骨折的足后钉与其他固定方法的并发症发生率相当。由于植入物固定不良而消除距下关节运动和植入物并发症的问题仍然存在。迄今为止的文献主要由IV级研究组成，有相当大的偏见。需要进一步研究以阐明后足钉在急性踝关节和Pilon骨折中的作用。
治疗级别IV。有关证据级别的完整描述，请参阅作者说明。
