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Julie J. Willeumier Department of Orthopaedics, Leiden University Medical Centre, The Netherlands

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Yvette M. van der Linden Department of Orthopaedics, Leiden University Medical Centre, The Netherlands

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Michiel A.J. van de Sande Department of Orthopaedics, Leiden University Medical Centre, The Netherlands

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P.D. Sander Dijkstra Department of Orthopaedics, Leiden University Medical Centre, The Netherlands

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to pain, pathological fractures, immobility, decreased functioning, and hypercalcaemia. Over half of patients experience clinical symptoms for which treatment is required, 3 of whom only a minority are surgically treated. 4 In the long bones

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Elisa Pala Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy

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Alberto Procura Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy

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Giulia Trovarelli Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy

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Antonio Berizzi Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy

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Pietro Ruggieri Department of Orthopedics and Orthopedic Oncology, University of Padova, Padova, Italy

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(range: 51.4–91.9 years old) ( Table 1 ). Five patients presented multiple lesions requiring nailing: 52 IM nail fixations were performed. Indications to treatment were (i) impending fracture (21 cases) or pathologic fracture (30 cases) due to long bone

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Stijn E. W. Geraets Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

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P. Koen Bos Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

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Johan van der Stok Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

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with impending or actual pathological fractures. 5 Those impending or actual pathological fractures regularly require surgical treatment in order to prevent or stabilize fractures. Surgical procedures used to stabilize impending or actual

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Miklós Szendrői Department of Orthopaedics, Semmelweis University, H-1082 Budapest, Üllői 78/b, Hungary

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Imre Antal Department of Orthopaedics, Semmelweis University, H-1082 Budapest, Üllői 78/b, Hungary

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Attila Szendrői Department of Urology, Semmelweis University, H-1082 Budapest, Üllői 78/b, Hungary

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Áron Lazáry National Center for Spinal Disorders, H-1126 Budapest, Királyhágó u.1., Hungary

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Péter Pál Varga National Center for Spinal Disorders, H-1126 Budapest, Királyhágó u.1., Hungary

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finding the primary tumour site, but should be the last procedure in the diagnostic work-up because it weakens the affected bone and can lead to a pathological fracture. Approximately 20% of patients with bone metastases are referred with an actual

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Thomas Tampere Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium

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Matthieu Ollivier Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France

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Christophe Jacquet Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France

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Maxime Fabre-Aubrespy Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France

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Sébastien Parratte Institute for Locomotion, Aix-Marseille University, St. Marguerite Hospital, Marseille, France
Department of Orthopaedic Surgery, International Knee and Joint Centre, Abu Dhabi, UAE

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inadequate reduction of the articular step-off, secondary loss of reduction and material cut-out. 2 – 17 Thirdly, use of TKA might be indicated for pathological fractures of the distal femur and/or tibia in cases with poor bone stock or profound condylar

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Victor Lu School of Clinical Medicine, University of Cambridge, Cambridge, UK

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Maria Tennyson Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, UK

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Andrew Zhou School of Clinical Medicine, University of Cambridge, Cambridge, UK

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Ravi Patel Department of Trauma and Orthopaedics, Shrewsbury and Telford Hospital NHS Trust, UK

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Mary D Fortune Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

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Azeem Thahir Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, UK

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Matija Krkovic Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge, UK

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Introduction

  • Fragility ankle fractures are traditionally managed conservatively or with open reduction internal fixation. Tibiotalocalcaneal (TTC) nailing is an alternative option for the geriatric patient. This meta-analysis provides the most detailed analysis of TTC nailing for fragility ankle fractures.

Methods

  • A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, and Web of Science, identifying 14 studies for inclusion. Studies including patients with a fragility ankle fracture, defined according to NICE guidelines as a low-energy fracture obtained following a fall from standing height or less, that were treated with TTC nail were included. Patients with a previous fracture of the ipsilateral limb, fibular nails, and pathological fractures were excluded. This review was registered in PROSPERO (ID: CRD42021258893).

Results

  • A total of 312 ankle fractures were included. The mean age was 77.3 years old. In this study, 26.9% were male, and 41.9% were diabetics. The pooled proportion of superficial infection was 10% (95% CI: 0.06–0.16), deep infection 8% (95% CI: 0.06–0.11), implant failure 11% (95% CI: 0.07–0.15), malunion 11% (95% CI: 0.06–0.18), and all-cause mortality 27% (95% CI: 0.20–0.34). The pooled mean post-operative Olerud–Molander ankle score was 54.07 (95% CI: 48.98–59.16). Egger’s test (P = 0.56) showed no significant publication bias.

Conclusion

  • TTC nailing is an adequate alternative option for fragility ankle fractures. However, current evidence includes mainly case series with inconsistent post-operative rehabilitation protocols. Prospective randomised control trials with long follow-up times and large cohort sizes are needed to guide the use of TTC nailing for ankle fractures.

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Catalin Cirstoiu Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Bogdan Cretu Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Sergiu Iordache Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Mihnea Popa Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Bogdan Serban Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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Adrian Cursaru Orthopedics and Traumatology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Orthopedics and Traumatology Department, University Emergency Hospital Bucharest, Bucharest, Romania

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-old woman with bilateral subtrochanteric pathological fractures secondary to a cervical neoplasm, recently treated on the left side with a cephalointramedullary nail. (B) Postoperative image of the right femur after fracture fixation with a long

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Joaquim Soares do Brito Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal

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André Spranger Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal

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Paulo Almeida Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal

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José Portela Orthopedics Department, University Hospital of Santa Maria, Lisbon, Portugal

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Irene Barrientos-Ruiz Orthopedics Department, University Hospital of La Paz, Madrid

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the curettage technique, and even though Campanacci grade III tumours seem to recur more often after curettage, the recurrence rates herein presented are often low. In this setting, it is important to highlight a trend toward pathologic fractures at

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Olga D. Savvidou First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Panagiotis Koutsouradis Department of Orthopaedic Surgery, 417 Veterans Hospital (NIMTS), Athens, Greece

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George D. Chloros First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Ioannis Papanastasiou First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Thomas Sarlikiotis First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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Aggelos Kaspiris Laboratory of Molecular Pharmacology/ Sector for Bone Research, School of Health Sciences, University of Patras, Patras, Greece

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Panayiotis J. Papagelopoulos First Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, ‘ATTIKON’ Hospital, Athens, Greece

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However, studies have also demonstrated the clonal neoplastic nature of the cyst. 56 Patients usually present with pain, swelling, enlarging mass and even a pathologic fracture in the elbow area. The symptoms are usually presented for several weeks

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Hagen Fritzsche University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse, Dresden, Germany

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Anne Weidlich University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse, Dresden, Germany

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Klaus-Dieter Schaser University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse, Dresden, Germany

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Elisabeth Mehnert University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse, Dresden, Germany

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Doreen Winkler University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse, Dresden, Germany

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Stefan Rammelt University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse, Dresden, Germany

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tumours or those that have resulted or may lead to pathological fractures should be treated by surgery, although they are benign. In case of complaints, functional deficits or a threat to stability, an intralesional resection is possible in benign lesions

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