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

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

doi:10.1016/j.fas.2022.02.005

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

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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

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

Foot and ankle surgery, Vol.28(7), pp.986-994

10/01/2022

DOI: 10.1016/j.fas.2022.02.005

PMID: 35184992

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Abstract

Purpose: This study aims to provide an updated systematic review and meta-analysis of comparative stu-dies on the outcomes and complications of locked IMNs in comparison to ORIF using plates and screws, while avoiding limitations of similar published reviews.Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two independent team members electronically searched MEDLINE (PubMed), EMBASE, Google Scholar, SCOPUS, and Cochrane databases throughout May 2021 using the following keywords with their synonyms: "Ankle fracture fixation" AND "Open reduction and internal fixation", "locked intramedullary nail", or "complications". The primary outcomes were (1) functional outcomes, (2) complications, and (3) reoperation, while the secondary outcomes were: (1) union rate, and (2) cost. Inclusion criteria: com-parative studies on outcomes and complications of plate open reduction and internal fixation (ORIF) vs. locked intramedullary nailing (IMN) of ankle fractures reporting at least one of the following parameters: functional outcomes, complications (infection, dehiscence, reoperation etc.), union, and cost. Studies re-porting on non-locked intramedullary fibular nails were also excluded.Results: After the removal of duplicates, a total of 1461 studies were identified. After screening those records, 63 studies remained for full-text assessment. Out of those, four comparative studies with a total of 262 ankle fractures met the inclusion criteria for this meta-analysis. The mean 12 months postoperative Olerud and Molander Ankle Scores (OMAS) were reported by two studies, with a statistically significant difference in favor of IMNs (MD= 6.72, CI: 3.77-9.67, p < 0.001, I2= 94%). In the ORIF group, the overall complication rate was 39/134 (29.1%) vs. 10/128 (7.8%) in the IMN group, with a statistically significant difference in favor of the IMN group (RR=3.23, CI:1.71-6.11, p < 0.001, I2=34%). In the ORIF group, the overall infection rate was 11/134 (8.2%), while there were no infections in the IMN group, with a statistically significant difference in favor of the IMN group (RR=8.05, CI:1.51-42.82, p=0.01, I2=0%). In the ORIF group, the overall reoperation rate was 10/134 (7.5%) while the overall reoperation rate was 6/128 (4.7%) in the IMN group, with no statistically significant difference between groups (RR=1.49, CI: 0.60-3.70, p = 0.39, I2=0%).Conclusion: Locked intramedullary nail fixation of distal fibula fractures could provide superior functional outcomes and lower complication rates in comparison to open reduction and plate fixation. Despite the high incidence of ankle fractures, the number of high-quality comparative studies remains limited in lit-erature, especially on newer locked fibular nails, and large multicentric clinical trials are required before recommending locked IMNs as the new standard of care in distal fibula fractures.(c) 2022 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

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Title: Subtitle: 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
Creators: Ahmed Khalil Attia - Penn State Milton S. Hershey Medical Center
Aly Fayed - Tanta University
Karim Mahmoud - Emory University Hospital
Sameh A. Labib - Emory University Hospital
Umur Aydogan - Penn State Milton S. Hershey Medical Center
Paul Juliano - Penn State Milton S. Hershey Medical Center
Resource Type: Journal article
Publication Details: Foot and ankle surgery, Vol.28(7), pp.986-994
DOI: 10.1016/j.fas.2022.02.005
PMID: 35184992
NLM abbreviation: Foot Ankle Surg
ISSN: 1268-7731
eISSN: 1460-9584
Publisher: Elsevier
Number of pages: 9
Language: English
Date published: 10/01/2022
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984949189502771

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