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Can Locked Fibula Nail Replace Plate Fixation for Treatment of Acute Ankle Fracture? A Systematic Review and Meta-Analysis

  • Author Footnotes
    # These authors contributed equally to this work.
    Wenxuan Guo
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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  • Author Footnotes
    # These authors contributed equally to this work.
    Fan Wu
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.
    Wenhuan Chen
    Footnotes
    # These authors contributed equally to this work.
    Affiliations
    Third Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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  • Kun Tian
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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  • Rujie Zhuang
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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  • Yu Pan
    Correspondence
    Address correspondence to: Yu Pan, MD, Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, No. 54, Youdian Road, Shangcheng District, Hangzhou 310003, Zhejiang, China.
    Affiliations
    Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
    Search for articles by this author
  • Author Footnotes
    # These authors contributed equally to this work.
Published:October 12, 2022DOI:https://doi.org/10.1053/j.jfas.2022.10.003

      Abstract

      The standard surgical treatment for unstable ankle fractures involves open reduction and internal fixation (ORIF) with plates. However, ORIF has been associated with several complications, such as soft tissue irritation, wound infection, and nerve injury. Previous studies have shown that closed reduction and internal fixation with locked intramedullary nails (LIMNs) yields satisfactory efficacy in the treatment of ankle fractures and is associated with low complication rates. Therefore, a systematic review and meta-analysis of randomized controlled trials is imperative to provide evidence on whether or not LIMN fixation is comparable to or superior than traditional ORIF. We conducted a comprehensive literature search in the PubMed, Cochrane Library and EMBASE databases. A total of 4 randomized controlled trials involving 359 participants who suffered ankle fractures were included in this systematic review and meta-analysis. The results showed that the LIMN fixation group was statistically significant in terms of functional outcomes at the 3-month follow-up and wound-related complications. There was no statistical advantage for patients in the LIMN fixation group in terms of nonwound-related complications, total complications, or mid-term follow-up functional outcomes. There was no statistical difference between the LIMN and ORIF groups regarding operation time and quality of reduction. We believe LIMN fixation is a viable option for the treatment of unstable ankle fractures in both young and elderly individuals.

      Level of Clinical Evidence

      Keywords

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