Can locked fibula nail replace plate fixation for treatment of acute ankle fracture? A protocol for systematic review and meta-analysis of randomized controlled trials

Abstract

Review question / Objective: We seek to conduct a meta-analysis of relevant studies to evaluate and compare functional outcomes and complication rates between locked fibula intramedullary nail fixation and plate fixation for treatment of ankle fractures. Condition being studied: Ankle fractures, with an incidence rate of 4.22/10, 000 person-years in the United States, are one of the most common lower extremity fractures. Currently, the standard surgical treatment approaches for unstable ankle fractures involves open reduction and internal fixation (ORIF) with plates and screws. However, ORIF has resulted in little efficacy during treatment of fractures since the 1960s, while plate and screw fixation has also been associated with several complications. Previous studies have shown that closed reduction and internal fixation (CRIF) with fibula intramedullary nail (IMN) has achieved satisfactory efficacy in treatment of ankle fractures, and is associated with low complication rates. Additionally, a systematic review showed that a locked intramedullary nail (LIMN) device provides better stability and rotation control, thereby reducing the risk of nail migration and loss of fixation, compared to unlocked nails. Therefore, a meta-analysis is imperative to provide evidence on whether LIMN can replace PF for treatment of ankle fractures, owing to an increase in related studies that have been published in recent years.