Clinical outcomes in the surgical management of ankle fractures: A systematic review and meta-analysis of fibular intramedullary nail fixation vs. open reduction and internal fixation in randomized controlled trials

Walsh, John P.; Hsiao, Mark S; LeCavalier, Daniel; McDermott, Ryland; Gupta, Shivali; Watson, Troy S.

doi:10.1016/j.fas.2022.03.009

Cited by 7 publications

(4 citation statements)

References 83 publications

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“…There is evidence in the clinical trials that the fibula nail may present advantages due to fewer wound complications [ 26 , 27 , 28 ]. A systematic review and meta-analysis conducted in 2022 that included randomized clinical trials concluded that there is good evidence for comparable clinical outcomes between the fibula nail and ORIF [ 29 ]. With moderate safety, to date, fewer postoperative complications can be expected [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review and meta-analysis conducted in 2022 that included randomized clinical trials concluded that there is good evidence for comparable clinical outcomes between the fibula nail and ORIF [ 29 ]. With moderate safety, to date, fewer postoperative complications can be expected [ 29 ]. A technique-related disadvantage is that closed reduction makes the anatomical restoration of the ankle difficult.…”

Section: Discussionmentioning

confidence: 99%

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Fibula Nail versus Locking Plate Fixation—A Biomechanical Study

Kohler

Schenk

Nies

et al. 2023

JCM

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In the treatment of ankle fractures, complications such as wound healing problems following open reduction and internal fixation are a major problem. An innovative alternative to this procedure offers a more minimally invasive nail stabilization. The purpose of this biomechanical study was to clarify whether this method was biomechanically comparable to the established method. First, the stability (range of motion, diastasis) and rotational stiffness of the native upper ankle were evaluated in eight pairs of native geriatric specimens. Subsequently, an unstable ankle fracture was created and fixed with a locking plate or a nail in a pairwise manner. The ankles showed significantly less stability and rotational stiffness properties after nail and plate fixations than the corresponding native ankles (p < 0.001 for all parameters). When comparing the two methods, both showed no differences in their range of motion (p = 0.694) and diastasis (p = 0.166). The nail also presented significantly greater rotational stiffness compared to the plate (p = 0.001). However, both fixations remained behind the native stability and rotational stiffness. Due to the comparable biomechanical properties of the nail and plate fixations, an early weight-bearing following nail fixation should be assessed on a case-by-case basis considering the severity of fractures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fibula Nail versus Locking Plate Fixation—A Biomechanical Study

Kohler

Schenk

Nies

et al. 2023

JCM

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“…Adequate fracture reduction is indispensable to prevent joint congruence and post-traumatic arthrosis (7) . Studies comparing intramedullary nails with locking plates show lower complication rates and greater resistance to nail failure, encouraging using this material in unstable ankle fractures (8,9) . In addition, a systematic review comparing functional results showed similar results between the two groups after 12 months (10) .…”

Section: Introductionmentioning

confidence: 94%

Treatment of ankle fractures with fibular nail: clinical and imaging evaluation

Gomes,

Magalhães

et al. 2024

J Foot Ankle

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Objetivo: Realizar uma avaliação clínica e imaginológica de pacientes com fraturas do tornozelo submetidos a osteossíntese com haste bloqueada, analisando o encurtamento da fíbula e redução tíbio-talar através de parâmetros de imagem bem estabelecidos na literatura. Métodos: Foram selecionados 25 pacientes operados pela técnica de haste intramedular bloqueada de fíbula, submetidos a cirurgia entre abril de 2018 e dezembro de 2022. Os pacientes tinham idade acima de 55 anos, com risco aumentado para complicações de cicatrização. Para avaliação clínica foram usados: escore AOFAS e escala visual analógica. Os parâmetros de imagem utilizados foram o ângulo talocrural, o espaço claro medial e a linha tibiofibular. Resultados: Foi avaliado escore AOFAS com média de 83,48 (± 15,34), com mínimo de 40 e máximo de 98 pontos. Na escala visual analógica de dor, a média foi 2,56 pontos (± 2,50), com mínimo de 0 e máximo de 8. Na linha anterior tibiofibular, a diferença entre a média e o valor de referência (2 mm) foi de 0,38 mm. Sobre o espaço claro medial, 100% apresentou valores dentro da referência (até 4 mm). Na análise do ângulo talocrural, a média das diferenças obtidas entre os valores de cada paciente e a referência se situaram dentro dos valores normais. Conclusão: A osteossíntese de fraturas do tornozelo com haste intramedular bloqueada é uma excelente alternativa nos pacientes idosos e com risco aumentado para complicações, conduzindo a bons resultados funcionais em seguimento de médio prazo, apesar de não mostrar uma redução satisfatória de redução da sindesmose na maioria dos casos

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“…6 Previous authors have reported no difference in functional outcome and a lower complication rate compared with plate fixation. [8][9][10] High-quality studies are, however, needed to allow conclusions to be drawn about the outcome of the fixation of unstable fractures of the ankle in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Higher complication rate after nail compared with plate fixation of ankle fractures in patients aged 60 years or older: a prospective, randomized controlled trial

Stake

Ræder

Gregersen

et al. 2023

The Bone & Joint Journal

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Aims The aim of this study was to compare the functional and radiological outcomes and the complication rate after nail and plate fixation of unstable fractures of the ankle in elderly patients. Methods In this multicentre study, 120 patients aged ≥ 60 years with an acute unstable AO/OTA type 44-B fracture of the ankle were randomized to fixation with either a nail or a plate and followed for 24 months after surgery. The primary outcome measure was the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score. Secondary outcome measures were the Manchester-Oxford Foot Questionnaire, the Olerud and Molander Ankle score, the EuroQol five-dimension questionnaire, a visual analogue score for pain, complications, the quality of reduction of the fracture, nonunion, and the development of osteoarthritis. Results At 24 months, the median AOFAS score was equivalent in the two groups (nail 90 (interquartile range (IQR) 82 to 100), plate 95 (IQR 87 to 100), p = 0.478). There were statistically more complications and secondary operations after nail than plate fixation (p = 0.024 and p = 0.028, respectively). There were no other significant differences in the outcomes between the two groups. Conclusion The functional outcome after nail and plate fixation was equivalent; however, the complication rate and number of secondary operations was significantly higher after nail fixation. These results suggest that plate fixation should usually be the treatment of choice for unstable ankle fractures in the elderly. Cite this article: Bone Joint J 2023;105-B(1):72–81.

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Clinical outcomes in the surgical management of ankle fractures: A systematic review and meta-analysis of fibular intramedullary nail fixation vs. open reduction and internal fixation in randomized controlled trials

Cited by 7 publications

References 83 publications

Fibula Nail versus Locking Plate Fixation—A Biomechanical Study

Fibula Nail versus Locking Plate Fixation—A Biomechanical Study

Treatment of ankle fractures with fibular nail: clinical and imaging evaluation

Higher complication rate after nail compared with plate fixation of ankle fractures in patients aged 60 years or older: a prospective, randomized controlled trial

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