ReviewIntrmedullary versus extramedullary fixation of lateral malleolus fractures

- The rate of wound infections was higher for the plate group.
- Design may account for the lower rates of malunion with some nails.
- Plate and screw fixation may cause more soft tissue irritation.
- Intramedullary nail fixation of the fibula may outperform conventional.
- There is a need for adequately powered, scientific trials.

IntroductionIntramedullary nails (IM nails) now include dedicated fibular nails for lateral malleolus fractures. This study reviewed nail versus plate for fixation of unstable ankle fractures.DesignSystematic review and meta-analysis of published reports.ResultsFour studies met the inclusion criteria, including 375 patients. Two included studies were randomised-control studies and two were non-randomised case series. The implants investigated included: Knowles Pins, Fibular Nails, Rush Rods and Inyo Nails. The overall risk of bias was high. Pooled data showed a statistically significant lower risk of wound infection (RR 0.10; 95% CI 0.02 to 0.44), symptomatic hardware (RR 0.14; 95% CI 0.05 to 0.35) and removal of hardware (RR 0.57; 95% CI 0.39 to 0.81) with intramedullary nail fixation.ConclusionsThere is a paucity of literature upon which to draw reliable conclusions. There was a high risk of bias towards favourable outcomes for the nail group. It would appear that intramedullary nail fixation of distal fibular fractures can outperform conventional fixation with plate and screws. There is a need for adequately powered, scientific trials.