Fig. 1.

Overall schedule of events for the Articular Pilon Fracture (ACTIVE) trial, from eligibility screening, enrolment, treatment and follow-up assessments. ^aPatient-reported outcome measures collected at baseline include the Disability Rating Index (DRI), Olerud and Molander Ankle Score (OMAS), and five-level EuroQol five-dimension score (EQ-5D-5L). ^bPatient medical background includes details on whether the patient is diabetic or is immunosuppressed, and details of any polytrauma present at baseline. ^cAll trial patients will receive standardized written physiotherapy advice. Any further rehabilitation input throughout their treatment pathway will be at the discretion of the clinical team. ^dPhysiotherapy logbooks completed to record all rehabilitation delivery within the Trust starting from enrolment. ^eAssessment for pin site infections will be made each time a patient with an external frame attends a hospital visit until the time that the frame is removed, generally before six months, and recorded on a specific Case Report Form (CRF). ^fRoutine imaging will be used to complete the bone healing assessment at 12 months post-randomization to assess for malunion, nonunion, and secondary arthritis.