Department of Orthopaedics, PGIMER, Chandigarh, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):75-89. doi: 10.1007/s00590-023-03694-9. Epub 2023 Sep 1.
A locking plate (LP) or non-locking plate (NLP) can be used for distal fibula fracture fixation. However, the advantages of LP over NLP in patients with distal fibula fractures are not clear. In terms of indications, the role of the two plates probably differs; however, to draw comparative conclusions, we conceptualized this systematic review and meta-analysis of studies that directly compared the two plates, wherein both groups' indications and baseline parameters were similar.
An electronic literature search was performed using PubMed/Medline, Embase, Scopus, and Cochrane Library databases for studies comparing the LP versus NLP fixation for the lateral malleolus fracture. A total of 18 studies were included in qualitative and quantitative analysis. A subgroup analysis was performed for patients aged < 55 years and patients aged > 55 years. The statistical analysis was performed by Review Manager Software version 5.4.1.
A meta-analysis of 4243 fractures was performed across 18 studies. The rate of fracture union and overall complication rates did not differ between the two fixation groups with an OR of 0.71 (95% CI 0.26, 1.96, p = 0.51 and 1.11 (95% CI 0.84, 1.47, p = 0.47, respectively. There is no difference in the reoperation rate due to minor or major complications between the two groups. There was no difference in functional outcome (MD -0.85, with 95% CI -5.63, 3.93, p = 0.73), but NLP has a shorter surgical duration (MD 3.0, with 95% CI 0.26, 5.75, p = 0.03). A leave-one-out sensitivity analysis performed for overall complications affected the final outcome of the meta-analysis.
This meta-analysis demonstrates no clear benefit in selecting LP over NLP for the fixation of lateral malleolus fractures.
锁定钢板（LP）或非锁定钢板（NLP）可用于固定腓骨远端骨折。然而，LP 相对于 NLP 在治疗腓骨远端骨折患者的优势尚不清楚。在适应证方面，两种钢板的作用可能不同；然而，为了得出比较性结论，我们设计了这项系统评价和荟萃分析，比较了这两种钢板的研究，其中两组的适应证和基线参数相似。
使用 PubMed/Medline、Embase、Scopus 和 Cochrane 图书馆数据库进行电子文献检索，以比较 LP 与 NLP 固定外踝骨折的研究。共有 18 项研究纳入定性和定量分析。对年龄<55 岁和年龄>55 岁的患者进行亚组分析。统计分析采用 Review Manager Software 版本 5.4.1。
对 18 项研究的 4243 例骨折进行了荟萃分析。两组的骨折愈合率和总体并发症发生率无差异，OR 值分别为 0.71（95%CI 0.26，1.96，p=0.51）和 1.11（95%CI 0.84，1.47，p=0.47）。两组因轻微或严重并发症而再次手术的发生率无差异。两组的功能结局（MD-0.85，95%CI-5.63，3.93，p=0.73）无差异，但 NLP 的手术时间更短（MD 3.0，95%CI 0.26，5.75，p=0.03）。对总体并发症进行的逐一剔除敏感性分析影响了荟萃分析的最终结果。
这项荟萃分析表明，在固定外踝骨折时，选择 LP 并不优于 NLP。
