Abstract
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.
Highlights
Overall, intramedullary fixation of unstable distal fibular fractures can give excellent results that are comparable with modern plating techniques
As yet, there is unconvincing evidence that it is superior to standard techniques with regards to clinical and functional outcome
Ankle fractures were first described by Sir Percival Pott in 1768 and are one of the most common skeletal injuries seen in clinical practice [1]
Summary
17 studies were selected for review with regards to both clinical and functional outcome [21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37]. Three studies involve intramedullary screw fixation [24, 25, 31], and 14 studies involved IMN [21,22,23, 26,27,28,29,30, 32,33,34,35,36,37] of distal fibular fractures. Due to the inherent differences in these fixation methods, these techniques were analysed separately. Studies involving IMN were subdivided into those using unlocked and those using locked nails. Due to the heterogeneity of the study population and fixation devices, data synthesis was not possible for an accurate meta-analysis
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