General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China.
West China School of Nursing, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan Province, People's Republic of China.
J Orthop Surg Res. 2024 Sep 5;19(1):542. doi: 10.1186/s13018-024-05032-z.
The effectiveness and safety of fibular intramedullary nail fixation (FINF) compared to plate fixation (PF) in treating ankle fractures among adults remains unclear. Therefore, we conducted a meta-analysis to assess the efficacy and safety of FINF versus PF, aiming to provide orthopedic surgeons with valuable insights when choosing between the two internal fixation methods for patient treatment.
PubMed, EMBASE, and SCOPUS were systematically searched for articles comparing FINF and PF in ankle fractures among adults. Functional outcomes, complications, and bony union were compared between the implants.
A total of seven studies were included in the study, involving 586 patients. The results revealed no statistically significant differences in functional outcomes between two groups at 3, 6, and 12 months postoperatively. The outcomes favoring FINF comprised a lower infection rate (RR = 0.23, 95%CI, 0.11 to 0.47, P < 0.0001). Conversely, the PF group exhibited a superior performance in terms of hardware failure rate (RR = 2.05, 95%CI, 1.16 to 3.60, P = 0.01). A statistically significant difference was observed in the results of hardware failure rate in the subgroup of studies conducted in Europe (RR = 2.74, 95%CI, 1.45 to 5.18, P = 0.002). Comparable findings were also noted in a subgroup of older adults (RR = 4.25, 95%CI, 1.57 to 11.50, P = 0.004).
This systematic review suggests that FINF exhibits comparable effectiveness in the management of ankle fractures among adults, as compared to PF. Consequently, it is imperative to further delineate the surgical indications for both FINF and PF with precision to mitigate the risk of complications. Nevertheless, larger sample sizes and multi-center RCTs are imperative to corroborate this conclusion in the future.
腓骨骨髓内钉固定（FINF）与钢板固定（PF）治疗成人踝关节骨折的疗效和安全性仍不清楚。因此，我们进行了一项荟萃分析，以评估 FINF 与 PF 的疗效和安全性，旨在为骨科医生在选择这两种内固定方法治疗患者时提供有价值的见解。
系统检索 PubMed、EMBASE 和 SCOPUS 中比较成人踝关节骨折中 FINF 和 PF 的文章。比较两种植入物的功能结果、并发症和骨愈合情况。
共纳入 7 项研究，共 586 例患者。结果显示，两组患者术后 3、6 和 12 个月的功能结果无统计学差异。结果有利于 FINF 的方面包括感染率较低（RR=0.23，95%CI，0.11 至 0.47，P<0.0001）。相反，PF 组在硬件失败率方面表现更好（RR=2.05，95%CI，1.16 至 3.60，P=0.01）。在欧洲进行的研究亚组中，硬件失败率的结果存在统计学显著差异（RR=2.74，95%CI，1.45 至 5.18，P=0.002）。在老年亚组中也观察到类似的结果（RR=4.25，95%CI，1.57 至 11.50，P=0.004）。
本系统评价表明，与 PF 相比，FINF 在治疗成人踝关节骨折方面具有相当的疗效。因此，进一步明确 FINF 和 PF 的手术适应证至关重要，以降低并发症风险。然而，未来需要更大的样本量和多中心 RCT 来证实这一结论。
