Letter to the editor on: "Formal joint preparation appears to not be necessary for surgical treatment of ankle fractures with tibiotalocalcaneal nailing: a systematic review".

This correspondence concerns a systematic review reporting that formal joint preparation is not necessary during tibiotalocalcaneal nailing for ankle fractures. The review's principal outcome is fracture union, whereas joint preparation is undertaken to achieve arthrodesis, and radiographic fusion is reported in only one of the seven included studies, where both joints fused in 18.2% of patients. The conclusion therefore rests on an endpoint the intervention is not intended to influence, a limitation acknowledged in the discussion but not in the title or conclusion. Three discrepancies are also identified from the published tables: the union numerators sum to 127 rather than the reported 114, and reconcile exactly when the unprepped figure given in the Results is substituted for one study entered at its full-cohort value; a rate printed as 88% is 77.8%; and complication and reoperation rates are calculated on denominators from which two patients were removed while their events were retained. The remedies proposed are re-tabulations of existing data rather than new analyses.