Abstract：
Unstable ankle fractures are traditionally treated with open reduction and internal fixation. An alternative surgical option is primary tibio-talar-calcaneal fusion. Our aims were to determine the indication, complication rates, and functional outcomes, of tibio-talar-calcaneal nailing when used as the primary treatment of ankle fractures. A multidatabase literature search was performed on December 14, 2019 according to PRISMA guidelines. All studies in the English language reporting complications and outcomes involving tibio-talar-calcaneal nailing for primary treatment of ankle fractures were included. Ten studies with 252 ankle fractures were included. Mean age of patients was 75.5 (32-101) years. Mean follow-up duration was 79 weeks (36-104 weeks). Surgical site infection occurred in 11.2% (95% confidence interval [CI] 6.3%-19%) of patients, implant failure occurred in 8.1% (95% CI 5%-12.8%) of patients, and unplanned return to operating room occurred in 10.1% (95% CI 6.1%-16.2%) of patients. There were no cases of wound dehiscence. All-cause mortality rate at the end of follow-up was 26.6% (95% CI 19.7%-34.9%). Average reduction in Olerud-Molander Ankle Score after surgery was 7.9 points (5.0-11.8). Eighty-one point five percent (95% CI: 67.4%-90.4%) of patients were able to return to similar preoperative mobility aid after surgery. Tibio-talar-calcaneal nailing is an alternative procedure for patients who have sustained fractures unsuitable for nonoperative management, but have low functional demands and at increased risks of complications after open reduction and internal fixation. About 81.5% (95% CI 67.4%-90.4%) of patients were able to return to a similar preinjury mobility status after tibio-talar-calcaneal nailing.
摘要：
不稳定的踝关节骨折传统上采用切开复位和内固定治疗。另一种手术选择是原发性胫骨-距骨-跟骨融合。我们的目标是确定适应症，并发症发生率,和功能结果，胫骨-距骨-跟骨钉作为踝关节骨折的主要治疗方法。根据PRISMA指南，于2019年12月14日进行了多数据库文献检索。包括所有英语语言报告的并发症和结果的研究，涉及胫骨-距骨-跟骨钉用于踝关节骨折的主要治疗。纳入了十项252例踝关节骨折的研究。患者的平均年龄为75.5(32-101)岁。平均随访时间为79周（36-104周）。手术部位感染发生在11.2％（95％置信区间[CI]6.3％-19％）的患者中，植入物失败发生在8.1%(95%CI5%-12.8%)的患者中，10.1%(95%CI6.1%-16.2%)的患者发生计划外返回手术室.没有伤口裂开的病例。随访结束时全因死亡率为26.6%(95%CI19.7%-34.9%)。术后Olerud-Molander踝关节评分平均降低7.9分(5.0-11.8)。百分之八十一点五（95％CI：67.4％-90.4％）的患者能够在手术后恢复类似的术前活动辅助。对于不适合非手术治疗的持续骨折患者，胫骨-距骨-跟骨钉是一种替代方法。但对功能要求较低，切开复位内固定术后并发症的风险增加。大约81.5％（95％CI67.4％-90.4％）的患者在胫骨-距骨-跟骨钉后能够恢复到类似的损伤前活动状态。
