BackgroundAnkle fractures are extremely common and represent nearly one quarter of all lower-limb fractures. In the majority of patients, fractures involve the distal fibula. The current standard in treating unstable fractures is through open reduction and internal fixation (ORIF) with plates and screws. Due to concerns with potentially devastating wound complications, minimally invasive strategies such as intramedullary fixation have been introduced. This systematic review was performed to evaluate the clinical and functional outcomes of intramedullary fixation of distal fibular fractures using either compression screws or nails.Materials and methodsNumerous databases (MEDLINE, PubMed, Embase, Google Scholar) were searched, 17 studies consisting of 1,008 patients with distal fibular fractures treated with intramedullary fixation were found.ResultsMean rate of union was 98.5 %, with functional outcome reported as being good or excellent in up to 91.3 % of patients. Regarding unlocked intramedullary nailing, the mean rate of union was 100 %, with up to 92 % of patients reporting good or excellent functional outcomes. Considering locked intramedullary nailing, the mean rate of union was 98 %, with the majority of patients reporting good or excellent functional outcomes. The mean complication rate across studies was 10.3 %, with issues such as implant-related problems requiring metalwork removal, fibular shortening and metalwork failure predominating.ConclusionOverall, intramedullary fixation of unstable distal fibular fractures can give excellent results that are comparable with modern plating techniques. However, as yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcome.Level of evidenceLevel IV evidence.

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Revision hip arthroplasty in the presence of severe acetabular bone loss is challenging and requires a solid understanding of current techniques. A literature search of multiple databases applying specific criteria revealed a total of 50 articles of level IV scientific evidence comprising 2415 patients (2480 hips) managed with reinforcement devices (roof-reinforcement rings and anti-protrusio cages), custom-made triflanged acetabular components (CTACs), jumbo cups and tantalum metal (TM) systems. Overall, patients had improved postoperative hip scores for each technique. The use of reinforcement devices resulted in a mean revision rate of 8.2% and a mean complication rate of 29.21%. CTACs were associated with a revision rate of 15.9% and had a complication rate of 24.5%. Jumbo cups were revised in 8.8% of patients and had a complication rate of 18.4%. TM systems had an overall revision rate of 8.5% with complications seen in 18.5% of patients. CTACs had considerably higher revision rates compared to the other techniques. Jumbo cups and TM systems had lower complication rates compared to the use of reinforcement devices and CTACs. The most frequently occurring complications seen throughout the series were aseptic loosening, dislocation and infection.

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