Intramedullary Nailing Versus Open Reduction and Plate Fixation for Lateral Malleolar Fractures: A Meta-Analysis

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• The optimal surgical fixation for lateral malleolar fractures within ankle fractures remains debated.
• Both intramedullary nail (IMN) and plate fixation methods are employed, each with potential advantages and disadvantages.

Purpose of the Study:

• To compare clinical and radiological outcomes of intramedullary nail (IMN) versus plate fixation for lateral malleolar fractures.
• To provide evidence-based guidance on the preferred fixation method for these common ankle injuries.

Main Methods:

• A systematic meta-analysis of randomized controlled trials (RCTs) sourced from PubMed, EMBASE, and Cochrane Library up to June 2023.
• Seven RCTs with moderate to high methodological quality were included, with data synthesized using RevMan 5.3 software.

Main Results:

• The intramedullary nail (IMN) group exhibited a significantly lower infection rate compared to the plate group (RR = 0.38; p = .01).
• No statistically significant differences were observed between IMN and plate fixation regarding Olerud and Molander Ankle Score (OMAS), union rate, radiological outcomes, nerve injury, reoperation rates, loss of reduction, or overall complications.

Conclusions:

• Intramedullary nail (IMN) fixation appears to be a favorable option for lateral malleolar fractures due to a significantly reduced infection risk.
• While infection rates differ, IMN and plate fixation demonstrate comparable results for other key clinical and radiological outcomes in ankle fracture management.