PA Screw Versus Plate Fixation for Posterior Malleolar Fracture, Systematic Review and Meta-analysis of Complications and Functional Results.

Fixation methods for posterior malleolar fracture (PMF) are a source of great controversy. This study aims to compare complications, clinical, and radiological outcomes between PA screws and posterior plate in PMF using current literature. A systematic search strategy was conducted following the PRISMA protocol. Medline (PubMed), Embase (Elsevier), and Lilacs databases were used to identify complication rates (infection, nonunion, loss of reduction, osteoarthrosis, and sural nerve injury) and to compare reported functional outcomes. The level of evidence in the articles was assessed using the GRADE tool. The studies eligible for meta-analysis were processed using The Review Manager version 5.4.1 software. Twelve articles met the inclusion criteria; 5 articles were included for subgroup meta-analysis. Overall infection rate, loss of reduction and sural nerve injury were each 2%. Osteoarthritis rate was 10%. There was no difference in risk reduction for infection rate (RD = 0.01; 95% CI: -0.03 to 0.06; p = .50), loss of reduction (RD = -0.00; 95% CI: -0.03 to 0.03; p = .88), sural nerve injury (RD = 0.01; 95% CI: -0.03 to 0.04; p = .70), osteoarthrosis (RD = -0.00; 95% CI: -0.09 to 0.09; p = .97), functional (MD = 0.70; 95% CI: -1.06 to 2.45; p = .44) or pain scores (MD = 0.12; 95% CI: -0.31 to 0.55; p = .58), nor deficit in dorsiflexion (MD= -0.26; 95% CI: -1.64 to 1.12; p = .71). There were no clinical nor radiological significant differences when comparing fixation of PMF with plates or PA screws. With current literature it is not possible to establish the superiority of either fixation.