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External Versus Internal Fixation Techniques for Ankle Arthrodesis: A Systematic Review and Meta-analysis
Abdulrahman O Al-Naseem1, Jafar Hayat2, Abdullah Addar3
1Division of Surgery and Interventional Science, University College London, London, United Kingdom.
Summary
Ankle arthrodesis using internal fixation (IF) and external fixation (EF) show similar union rates. However, external fixation is linked to higher infection and amputation risks, despite comparable pain and function.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
Background:
- Ankle arthrodesis is a surgical solution for end-stage ankle arthritis and deformity.
- Both internal fixation (IF) and external fixation (EF) are established techniques, but their comparative effectiveness remains debated.
Purpose of the Study:
- To systematically review and compare the safety and efficacy of IF versus EF for ankle arthrodesis.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched MEDLINE, EMBASE, and CENTRAL for studies comparing IF and EF ankle arthrodesis.
- Analyzed data using fixed and random effects models.
Main Results:
- Union rates were comparable between EF and IF groups (OR = 0.60, CI 0.36-1.02, p = .06).
- External fixation showed significantly higher odds of deep hardware infections (OR = 3.67) and amputations (OR = 3.17).
- Operation times and intraoperative blood loss were greater with EF; pain and functionality scores were similar.
Conclusions:
- Both IF and EF achieve reasonable union rates in ankle arthrodesis.
- EF is associated with increased risks of deep infection and amputation compared to IF.
- Postoperative outcomes regarding pain and function are comparable between the two fixation methods.
