Plate Versus Intramedullary Nail Fixation for Distal Fibula Fractures: A Systematic Review and Meta-Analysis of...

Area of Science:

• Orthopaedic Surgery
• Trauma Surgery
• Biomaterials Engineering

Background:

• Unstable distal fibula fractures present treatment challenges.
• Equipoise exists regarding the optimal surgical fixation method: intramedullary nail (IMN) versus plate fixation (PF).

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials (RCTs) comparing IMN and PF for unstable distal fibula fractures.
• To evaluate functional outcomes, union rates, complications, revision rates, and cost-effectiveness.

Main Methods:

• Systematic review and meta-analysis of published RCTs.
• Searched MEDLINE, EMBASE, and Cochrane databases.
• Assessed risk of bias using the Cochrane risk-of-bias v2.0 tool.

Main Results:

• Five RCTs with 455 patients (222 IMN, 233 PF) were included.
• No significant differences in functional outcomes (AOFAS, OMS scores) or union/complication rates between IMN and PF.
• One study indicated potential cost savings with IMN.

Conclusions:

• IMN and PF provide comparable functional recovery and complication profiles for distal fibula fractures.
• Patient-specific factors are crucial for selecting the appropriate fixation method.
• Further research, including larger longitudinal studies, is recommended to refine clinical guidelines and explore cost-effectiveness.