Frodl Andreas, Erdle Benjamin, Schmal Hagen
Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany.
University Hospital Odense, Dep. Of Orthopedic Surgery, Sdr. Boulevard 29, 5000 Odense C, Denmark.
EFORT Open Rev. 2021 Sep 14;6(9):816-822. doi: 10.1302/2058-5241.6.210003. eCollection 2021 Sep.
Fibular fixation to treat distal lower-leg fractures is a controversial intervention. To ensure better stability itself, better rotational stability, and to prevent secondary valgus dislocation - all these are justifications for addressing the fibula via osteosynthesis. High surgical costs followed by increased risks are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of malunion and malrotation, as well as infections and nonunions.We conducted a systematic review searching the Cochrane, PubMed, and Ovid databases. Inclusion criteria were modified Coleman Methodology Score (mCMS) > 60, a distal lower-leg fracture treated by nailing, and adult patients. Biomechanical and cadaver studies were excluded. Relevant articles were reviewed independently by referring to title and abstract. In a meta-analysis, we compared five studies and 741 patients.A significantly lower rate of valgus/varus deviation is associated with fixation of the fibula ( = 0.49; 95% CI: 0.29-0.82; p = .006). A higher risk for pseudarthrosis was revealed when the fibula underwent surgical therapy, but not significantly ( = 1.46; 95% CI: 0.76-2.79; p = .26). Nevertheless, we noted an increased risk of postoperative wound infection following fibular plating ( = 1.90; 95% CI: 1.21-2.99; p = .005). There was no statistically significant difference in the rate of nonunions between the two groups.Overall, the stabilization of the fibula may reduce secondary valgus/varus dislocation in distal lower-leg fractures but is associated with an increased risk of postoperative wound infections. The indication for fibula plating should be made individually. Cite this article: 2021;6:816-822. DOI: 10.1302/2058-5241.6.210003.
腓骨固定术治疗小腿下段骨折是一种存在争议的干预措施。为确保自身更好的稳定性、更好的旋转稳定性以及防止继发性外翻脱位——所有这些都是通过骨合成处理腓骨的理由。高昂的手术费用以及随之增加的风险是反对该手术的令人信服的理由。本研究的目的是系统回顾关于畸形愈合和旋转不良发生率以及感染和骨不连的文献。我们进行了一项系统回顾，检索了Cochrane、PubMed和Ovid数据库。纳入标准为改良科尔曼方法评分（mCMS）> 60、采用髓内钉治疗的小腿下段骨折以及成年患者。排除生物力学和尸体研究。通过查阅标题和摘要独立评审相关文章。在一项荟萃分析中，我们比较了5项研究和741例患者。腓骨固定与外翻/内翻偏差率显著降低相关（ = 0.49；95%置信区间：0.29 - 0.82；p = .006）。当腓骨接受手术治疗时，假关节形成风险更高，但差异无统计学意义（ = 1.46；95%置信区间：0.76 - 2.79；p = .26）。然而，我们注意到腓骨钢板固定术后伤口感染风险增加（ = 1.90；95%置信区间：1.21 - 2.99；p = .005）。两组之间骨不连发生率无统计学显著差异。总体而言，腓骨固定可能会减少小腿下段骨折的继发性外翻/内翻脱位，但与术后伤口感染风险增加相关。腓骨钢板固定的适应证应个体化确定。引用本文：2021；6：816 - 822。DOI：10.1302/2058 - 5241.6.210003。
