Splints versus external fixation in ankle fracture dislocations: A systematic review and meta-analysis

Ankle fracture-dislocations represent an injury pattern with potential for ongoing damage to soft tissues and bone if not managed appropriately and often require temporizing measures with a splint (S) or external fixation (EF) before definitive fixation. This review aims to compare the outcomes of splinting versus external fixation in ankle fracture-dislocations using existing literature.

A search was conducted across several databases (PubMed, Ovid Medline, Embase, SCOPUS, Cochrane Review, and clinicaltrials.gov). Studies were screened and included if they met eligibility criteria. Demographics and results of the studies were extracted from the articles that met inclusion criteria. Meta-analysis was performed and reported using odds ratios (OR).

This review included six studies comparing S to EF. Cohorts consisted of 547 and 427 patients, respectively. S maintained reduction in 73.1 % and EF maintained reduction in 96.8 %. Complications were reported in 9.5 % (S) and 14.1 % (EF). Meta-analysis determined that external fixation was nine times more likely to maintain reduction (OR: 9.24, p < 0.001). Skin necrosis, wound dehiscence, surgical site infection, and total complications were similar between groups based on meta-analysis results (p > 0.05).

This study demonstrates superiority of external fixation over splinting due to improved maintenance of reduction with an equivalent complication profile. Both external fixation and splinting are viable treatment options, and surgeons should weigh the risks and benefits of each procedure to optimize patient outcomes.