Priority 8 from the Complex Fractures PSP

UNCERTAINTY: When is it better to replace, fix or fuse fractures around the ankle, knee or acetabulum (hip socket)? (JLA PSP Priority 8)
Overall ranking	8
JLA question ID	0105/8
Explanatory note	Joint replacement, fixation with metalwork, and fusion with screws are all methods of treating fractures around joints. It is not well understood which injury pattern at each joint may benefit from each intervention. Furthermore, it is not known which patients may benefit from each.
Evidence	No specific NICE guidance exists on this question. A Cochrane review and several randomised controlled trials have been conducted to answer specific questions that fall under this uncertainty. Further studies are ongoing, none are likely to answer the question entirely. The Ankle Injury Management (AIM) Trial Effect of Locking Plate Fixation vs Intramedullary Nail Fixation on 6-Month Disability Among Adults With Displaced Fracture of the Distal Tibia The UK FixDT Randomized Clinical Trial Cochrane Review: Interventions for treating fractures of the distal femur in adults Fractures of the posterior wall of the acetabulum: Treatment using internal fixation of two parallel reconstruction plates Trial Single versus double column fixation in transverse fractures of the acetabulum: A randomised controlled trial AceFIT – a study comparing three methods of treatment of acetabular fractures (a type of hip fracture) in older patients; surgical fixation versus surgical fixation and hip replacement versus non-surgical treatment
Health Research Classification System category	Injuries and accidents

Extra information provided by this PSP
Original uncertainty examples	Managing osteoporotic fractures around the knee ~ Cost-benefit and cost-effectiveness studies on complex articular fractures and return to ambulation with emphasis on distal limb sensation/perfusion/chronic compartment syndromes of the foot in distal tibial trauma ~ What progress can be made on ankle replacement as the choice of fusion or amputation both effects any hope of returning to the manual work in the construction industry. ~ fix or replace acetabular fractures?
Submitted by	2 x Surgeon/Doctor, 1 x Unknown, 1 x Patient, 1 x Healthcare Professional (unspecified)

Extra information provided by this PSP

Original uncertainty examples

Managing osteoporotic fractures around the knee ~ Cost-benefit and cost-effectiveness studies on complex articular fractures and return to ambulation with emphasis on distal limb sensation/perfusion/chronic compartment syndromes of the foot in distal tibial trauma ~ What progress can be made on ankle replacement as the choice of fusion or amputation both effects any hope of returning to the manual work in the construction industry. ~ fix or replace acetabular fractures?

Submitted by

2 x Surgeon/Doctor, 1 x Unknown, 1 x Patient, 1 x Healthcare Professional (unspecified)

PSP information
PSP unique ID	0105
PSP name	Complex Fractures
Total number of uncertainties identified by this PSP.	58 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	8th June 2021