Distal Fibula Fractures—Intramedullary Fixation Versus Plating: A Systematic Review and Meta-analysis of Randomized Control Trials

Abstract

Purpose

The aim of the present study is to compare the functional scores and complications of intramedullary fixation versus plate osteosynthesis of distal fibular fractures in adults.

Methods

Study was performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses format from MEDLINE, Embase, Ovid, and Cochrane databases. The included articles were assessed according to the risk of bias assessment tool by Cochrane collaboration.

Results

A total of 5 randomized control trials were included for quantitative review. Random sequence generation and allocation concealment of the study subjects were the strengths of all the included studies. There was high heterogeneity among the included studies (I² > 75%). There was no significant difference between the Olerud-Molander scores in both the groups but the trend favored the intramedullary nailing of distal fibula (mean difference of 3.42, 95% confidence interval [CI] of 8.90). Complications were significantly lesser in the intramedullary group across the studies (odds ratio 0.26, 95% CI of 0.81).

Conclusion

Intramedullary nailing of fibula with the use of modern locking fibular nails is an alternative to fibular plating for unstable distal fibular fractures in properly selected cases. There remains the need for standardizing the method of operative treatment of distal fibular fractures which can be done by a well-planned large-scale prospective study design.

Level of Evidence:

Level 1

Keywords

distal fibula fibular intramedullary nailing fibular plating Olerud-Molander score

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References

Van Schie-Van der Weert

Van Lieshout

EMM

De Vries

Van der Elst

Schepers

Determinants of outcome in operatively and non-operatively treated Weber-B ankle fractures. Arch Orthop Trauma Surg. 2012;132(2):257-263. doi:10.1007/s00402-011-1397-z.

Rehman

Gardner

Rankin

Johnstone

AJ.

The implants used for intramedullary fixation of distal fibula fractures: a review of literature. Int J Surg. 2018;56:294-300. doi:10.1016/j.ijsu.2018.06.019.

Huang

Liu

, et al. Comparison of three plate system for lateral malleolar fixation. BMC Musculoskelet Disord. 2014;15(1):360. doi:10.1186/1471-2474-15-360.

Arlettaz

Blanc

Chevalley

[Fractures of the tibial pilon. Long-term retrospective study of 51 fractures treated with open reduction and osteosynthesis]. Rev Chir Orthop Reparatrice Appar Mot. 1998;84(2):180-188.

Giordano

Boni

Godoy-Santos

, et al. Nailing the fibula: alternative or standard treatment for lateral malleolar fracture fixation? A broken paradigm. Eur J Trauma Emerg Surg. 2021;47(6):1911-1920. doi:10.1007/s00068-020-01337-w.

Moher

Liberati

Tetzlaff

Altman

; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097.

RoB 2: A revised Cochrane risk-of-bias tool for randomized trials. https://methods.cochrane.org/bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials. Accessed December 20, 2021.

Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). Centre for Evidence-Based Medicine (CEBM), University of Oxford. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009. Accessed February 2, 2022.

Peng

Lin

Chen

Wang

Percutaneous compression cannulated screw fixation for ankle fractures. Int J Clin Exp Med. 2018;11(3):2489-2494.

10.

Pritchett

JW.

Rush rods versus plate osteosyntheses for unstable ankle fractures in the elderly. Orthop Rev. 1993;22(6):691-696.

11.

Asloum

Bedin

Roger

Charissoux

Arnaud

Mabit

Internal fixation of the fibula in ankle fractures: a prospective, randomized and comparative study: plating versus nailing. Orthop Traumatol Surg Res. 2014;100(suppl 4):S255-S259. doi:10.1016/j.otsr.2014.03.005.

12.

White

Bugler

Appleton

Will

McQueen

Court-Brown

. A prospective randomised controlled trial of the fibular nail versus standard open reduction and internal fixation for fixation of ankle fractures in elderly patients. Bone Joint J. 2016;98-B(9):1248-1252. doi:10.1302/0301-620X.98B9.35837.

13.

Kho

Kim

Choi

SM.

Intramedullary nailing as an alternative to plate fixation in patients with distal fibular fracture. Orthop Traumatol Surg Res. 2020;106(1):149-154. doi:10.1016/j.otsr.2019.10.009.

14.

Badenhorst

Terblanche

Ferreria

Burger

MC.

Intramedullary fixation versus anatomically contoured plating of unstable ankle fractures: a randomized control trial. Int Orthop. 2020;44(3):561-568. doi:10.1007/s00264-020-04482-4.

15.

White

Bugler

Olsen

, et al. A prospective, randomized, controlled, two-center, international trial comparing the fibular nail with open reduction and internal fixation for unstable ankle fractures in younger patients. J Orthop Trauma. 2022;36(1):36-42. doi:10.1097/BOT.0000000000002140.

16.

Challagundla

Shewale

Cree

Hawkins

Intramedullary fixation of lateral malleolus using Fibula Rod System in ankle fractures in the elderly. Foot Ankle Surg. 2018;24(5):423-426. doi:10.1016/j.fas.2017.04.015.

17.

Bauer

Jonsson

Nilsson

Thirty-year follow-up of ankle fractures. Acta Orthop Scand. 1985;56(2):103-106. doi:10.3109/17453678508994329.

18.

Yde

Kristensen

KD.

Ankle fractures: supination-eversion fractures stage II primary and late results of operative and non-operative treatment. Acta Orthop Scand. 1980;51(1-6):695-701. doi:10.3109/17453678008990863.

19.

Donken

CCMA

Verhofstad

MHJ

Edwards

van Laarhoven

CJHM

. Twenty-two-year follow-up of pronation external rotation type III–IV (OTA type C) ankle fractures: a retrospective cohort study. J Orthop Trauma. 2012;26(8):e115-e122. doi:10.1097/BOT.0b013e31823bc320.

20.

Bilgetekin

Çatma

Öztürk

Ünlü

Ersan

Ö.

Comparison of different locking plate fixation methods in lateral malleolus fractures. Foot Ankle Surg. 2019;25(3):366-370. doi:10.1016/j.fas.2018.01.004.

21.

Herrera-Pérez

Gutiérrez-Morales

Guerra-Ferraz

Pais-Brito

Boluda-Mengod

Garcés

GL.

Locking versus non-locking one-third tubular plates for treating osteoporotic distal fibula fractures: a comparative study. Injury. 2017;48:S60-S65. doi:10.1016/S0020-1383(17)30796-9.

22.

Coifman

Bariteau

Shazar

Tenenbaum

SA.

Lateral malleolus closed reduction and internal fixation with intramedullary fibular rod using minimal invasive approach for the treatment of ankle fractures. Foot Ankle Surg. 2019;25(1):79-83. doi:10.1016/j.fas.2017.08.008.

23.

Shi

Luo

Weng

, et al. Optimally estimating the sample standard deviation from the five-number summary. Res Syn Meth. 2020;11:641-654.

24.

Wan

Wang

Liu

, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Medical Res Methodol. 2014;14:135.

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