Locked intramedullary nailing provides superior functional outcomes and lower complication rates than plate fixation of distal fibula fractures. A systematic review and meta-analysis of comparative studies

Attia, Ahmed Khalil; Fayed, Aly M.; Mahmoud, Karim; Labib, Sameh A.; Aydogan, Umur; Juliano, Paul J.

doi:10.1016/j.fas.2022.02.005

Cited by 6 publications

(6 citation statements)

References 26 publications

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“…Goss et al [23] mentioned in cadaver studies that peroneal tendons and the superficial peroneal nerve are at risk in nail fixation of distal fibula fractures. Removal of the locking screw may also be required in the fibular intramedüller fixation [7]. However, these complications were not observed in our study.…”

Section: Discussionmentioning

confidence: 65%

“…Intramedullary fixation of the fibula is a well-known method for managing ankle fractures [5]. The advantages of this approach include reduced complication rates, accelerated healing, reduced infection risk, and blood loss [6][7][8][9]. This study aims to investigate cases in which intramedullary fibular fixation was preferred due to the minimally invasive nature of the procedure in the management of ankle fractures with associated soft tissue damage, treated through a one-stage surgical procedure, particularly in patients for whom the use of plate and screw fixation was not suitable because of soft tissue damage.…”

Section: Introductionmentioning

confidence: 99%

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Intramedullary Fibular Fixation in One-Stage Ankle Fracture Surgery With Soft Tissue Damage: A Study of 19 Cases

Saygılı

2023

Cureus

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This study investigates the efficacy of one-stage surgical intramedullary fibular fixation in managing ankle fractures with associated soft tissue damage. Ankle fractures, often encountered, can lead to complications when coupled with soft tissue injury. Traditional plate and screw fixation can exacerbate infection risks and reduce wound healing. To address this, a minimally invasive approach employing intramedullary fixation of the fibula has been proposed. This retrospective analysis, conducted between 2019 and 2021, explores cases of intramedullary fibular fixation for ankle fractures with stage 2-3 soft tissue injuries. A total of 19 patients were included in the study. The procedure involved either ulna intramedullary nails or locking screws. Results indicate that the approach led to successful union (100%), one superficial infection (5.26%), and no complication was observed. While limitations include the retrospective nature and small sample size, this study contributes valuable insights into the use of intramedullary fibular fixation in one-stage surgery for ankle fractures with concurrent soft tissue damage.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Intramedullary Fibular Fixation in One-Stage Ankle Fracture Surgery With Soft Tissue Damage: A Study of 19 Cases

Saygılı

2023

Cureus

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“…Comparisons between union rates and reduction quality for IMN and ORIF have been reported previously in the literature and have found either no differences between both treatment modalities or superior outcomes with IMN. 9 , 47 , 48 Biomechanical analyses of ORIF and IMN have demonstrated comparable levels of diastasis, and while it has been suggested that nails might offer greater rotational stability, additional research is needed to determine whether this characteristic of nails conclusively led to better outcomes. 49 Previous reviews have identified either no differences in complication rates or lower complication rates with IMN.…”

Section: Discussionmentioning

confidence: 99%

“… 49 Previous reviews have identified either no differences in complication rates or lower complication rates with IMN. 9 , 47 , 48 Furthermore, two previous meta-analyses have identified markedly fewer wound complications with IMN, suggesting that in elderly patients, patients with chronic comorbidity, and patients with compromised soft tissue, IMN would be preferred over ORIF. 9 , 48 This study expands upon these findings by providing a more granular meta-analysis of the surgical time and AOFAS outcomes across four studies in comparison with the study by Guo et al, 48 which mentioned AOFAS score differences based on a single study and included surgical time from two studies.…”

Section: Discussionmentioning

confidence: 99%

“…This study was also limited in only extracting studies from one database; however, the reference lists of all included studies were screened, and any studies missed from the PRISMA screening were added manually. 47 , 48 In addition, intramedullary screws, while a valid method of fixation, were excluded from this analysis. The decision was based on the specific focus on comparing intramedullary nails with plate fixation; intramedullary screws may represent a fixation option that may have a more limited indication profile because of the lack of rotational control in maintaining certain fracture patterns.…”

Section: Discussionmentioning

confidence: 99%

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Intramedullary Fixation Versus Plate Fixation of Distal Fibular Fractures: A Systematic Review

Samuel,

Hong,

Deliso

et al. 2024

JAAOS Glob Res Rev

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Introduction: The purpose of this systematic review and meta-analysis was to provide an update of the recent literature comparing clinical outcomes of surgically treated fibular fractures using intramedullary nailing (IMN) with open reduction and internal plate fixation (ORIF). Methods: A literature search reporting clinical outcomes after IMN or ORIF of the distal fibula was conducted on PubMed. Inclusion criteria consisted of original studies; studies focusing on clinical outcomes after IMN or IMN and ORIF published before May 11, 2022; studies with at least 5 patients; and studies reporting union rates, complication rates, and patient-reported outcomes such as American Orthopaedic Foot and Ankle Society (AOFAS) and Olerud-Molander scores. Results: Of 2,394 studies identified, a total of 29 studies (4 LOE-I, 2 LOE-II, 6 LOE-III, 17 LOE-IV) were included consisting of 1,850 IMN patients and 514 plate patients. The pooled mean age of IMN patients was 58 years (95% confidence interval [CI], 54 to 62, I 2 = 42%) versus 57 years (95% CI, 53 to 62, I 2 = 49%) in ORIF. Union rates for IMN patients revealed a 99% union rate (95% CI, 0.98 to 1.00, I 2 = 20%) versus 97% union rate for ORIF patients (95% CI, 0.94 to 0.99, I 2 = 0%). Studies that compared IMN with ORIF revealed no difference in union rates (risk ratio [RR] = 0.99, 95% CI, 0.96 to 1.02, I 2 = 0%). IMN patients showed a 15% complication rate (95% CI, 0.09 to 0.23, I 2 = 89%), whereas plate patients had a complication rate of 30% (95% CI, 0.18 to 0.46, I 2 = 63%). When comparing studies with both treatments, IMN patients had a significantly lower risk of complications (RR = 0.49, 95% CI, 0.29 to 0.82, I 2 = 50%). The IMN group trended toward a higher mean AOFAS and Olerud-Molander score than the plate group by 4.53 (95% CI, −14.58 to 23.65, I 2 = 85%) and 3.54 (95% CI, −2.32 to 9.41, I 2 = 76%) points, respectively. Conclusion: Current literature reveals near equivalence in union rates and a markedly lower risk of complications when comparing IMN with plate fixation. While IMN patients had higher AOFAS and Olerud-Molander scores, these differences were not statistically significant. Notably, subgroup analyses indicated that rates of symptomatic implant and removal of implant were comparable between IMN and ORIF, which may indicate that wound-related complications were reduced in the minimally invasive IMN technique. While the high cost of IMN implants remains a barrier to their widespread adoption, the long-term benefits of reducing complications, specifically associated with wound complications in high-risk populations, may greatly improve quality of care for patients with distal fibula fractures. Additional research and cost-effectiveness analyses are warranted to fully assess the long-term benefits and economic feasibility of using IMN fixation for distal fibula fractures. Level of evidence: Therapeutic Level IV.

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Fracture-Related Infections in the Foot and Ankle

Krez,

Anastasio,

Adams

2024

Foot and Ankle Clinics

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Locked intramedullary nailing provides superior functional outcomes and lower complication rates than plate fixation of distal fibula fractures. A systematic review and meta-analysis of comparative studies

Cited by 6 publications

References 26 publications

Intramedullary Fibular Fixation in One-Stage Ankle Fracture Surgery With Soft Tissue Damage: A Study of 19 Cases

Intramedullary Fibular Fixation in One-Stage Ankle Fracture Surgery With Soft Tissue Damage: A Study of 19 Cases

Intramedullary Fixation Versus Plate Fixation of Distal Fibular Fractures: A Systematic Review

Fracture-Related Infections in the Foot and Ankle

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