One-third tubular plates versus anatomical distal fibula plates in ankle fracture fixation: a systematic review and meta-analysis.

PURPOSE

Ankle fractures, especially fractures of the distal fibula, are very common. This review aims to compare the postoperative clinical and radiological outcomes between one-third tubular plating and anatomical distal fibula plating.

METHODS

The PubMed, Embase, and Scopus databases were searched from inception to 29 June 2024. Data was extracted and analyzed by RevMan Web. Differences in operative times, and clinical and radiological outcomes were evaluated by mean difference (MD) with a 95% confidence interval (95%CI). Risks of various complications and mortality were assessed by risk ratio (RR) with 95%CI. The quality of studies was assessed using the Good Research for Comparative Effectiveness (GRACE) checklist.

RESULTS

A total of 14 studies comprising a total of 2,802 patients were included, 1,792 in the one-third tubular plating group, and 1,010 in the anatomical distal fibula plating group. There were no significant differences in ≥ 12 months post-operative AOFAS results, range of motion from full extension to full flexion, time to fracture union, superficial or deep infections, delayed wound healing, hardware irritation, hardware removal rates, revision surgery rates, non-union, and implant failures. However, one-third tubular plating had a significantly shorter operative time in minutes (MD = -11.41, 95%CI [-20.95, -1.87]; p = 0.02), a significantly lower risk of overall wound complications (RR = 0.55, 95%CI [0.40, 0.74]; p-value = 0.0001). The average GRACE score of the 14 observational studies was 10.6 (range 8-11), suggesting good methodological quality of these studies.

CONCLUSION

This systematic review and meta-analysis showed that one-third tubular plating had a significantly shorter operative time in minutes and a significantly lower risk of overall wound complications than anatomical distal fibula plating. As such, these factors should be taken into consideration and evaluated when choosing between one-third tubular plating and anatomical distal fibula plating in the management of an ankle fracture.