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

• Published in: Foot and ankle specialist Vol. 17; no. 6; p. 621
• Main Authors: Raj, Vikash, Barik, Sitanshu, Richa
• Format: Journal Article
• Language: English
• Published: United States 01.12.2024
• Subjects: Bone Plates; Fibula - injuries; Fibula - surgery; Fibula Fractures; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Fracture Fixation, Intramedullary - adverse effects; Fracture Fixation, Intramedullary - instrumentation; Fracture Fixation, Intramedullary - methods; Fractures, Bone - surgery; Humans; Randomized Controlled Trials as Topic; fibular intramedullary nailing; Olerud-Molander score; distal fibula; fibular plating
• DOI: 10.1177/19386400221118470

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. 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. 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 (I > 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). 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 1.