Open reduction and internal fixation compared to intramedullary nail fixation in distal fibula fractures: a meta-analysis

Abstract

The operative treatment of distal fibula fractures is debated. This study compared intramedullary nailing (IMN) versus open reduction and internal fixation (ORIF) in patients with distal fibula fractures. The outcomes of interest were patient-reported outcome measures (PROMs) and the rate of anatomic reduction, bony union, complication, and nerve injury. This study was conducted according to the 2020 PRISMA statement. In October 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase, with no time constraint. All the clinical studies comparing IMN versus ORIF in patients with distal fibula fractures were accessed. Data from 11 studies (1040 patients) were retrieved. The mean length of follow-up was 25.1 ± 16.4 months. The mean age of the patients was 56.6 ± 14.8 years, and the mean BMI was 27.3 ± 1.3 kg/m². A lower rate of nerve injury was evident in favour of the IMN group (P = 0.01). No further differences were found in the Olerud-Molander functional score (P = 0.07), the rate of anatomic reduction (P = 0.4), union (P = 0.9), and complications (P = 0.1). Concluding, osteosynthesis using ORIF might be associated with a greater nerve injury rate than IMN fixation in patients with distal fibula fractures; however, additional studies are required to establish the rate and type of nerve lesion. No difference was found in PROMs, rate of anatomic reduction, bony union, and other complications.