| Background Distal fibula fractures are common.At present,the most commonly used surgical treatment is still open reduction plate fixation,the placement of a fibular distal anatomical plate and screws fixation.However,postoperative complications are common.For example,patients complain of protrusion of internal fixation,pain,postoperative infection and loosening of internal fixation,which are more likely to occur in the elderly with chronic underlying diseases.In recent years,intramedullary fixation products have been updated a lot,and the application ratio has been gradually increased.It is characterized by minimally invasive fixation with small incision to protect the blood supply and soft tissue around the fracture and achieve functional reduction.However,there is still no conclusion on which treatment method is better and specific guidelines are recommended.The relevant Chinese and English databases have been consulted,and there is some controversy in the literature.Purpose To compare the curative effect of intramedullary fixation(IMF)and plate fixation(PF) on distal fibula fracture at home and abroad by using the method of Meta analysis,clarify the merits of the two treatments and Clarify the advantages and disadvantages of the two therapies to obtain more accurate and reliable results.Methods Search related information on zhiwang,wanfang,pubmed database,JBJS orthopedics and Google.To retrieve clinical controlled trials of intramedullary and plate fixation for distal fibula fractures from 2000 to 2020.Chinese search keywords:"distal fibula fracture","lateral malleolus fracture";English search keywords:"Fracture of distal fibula","Intramedullary fixation" and "Curative effect analysis","Danis-Weber".To collect and sort out Literature data and use RevMan 5.3 for statistical analysis.Result A total of 13 literatures were included,including 8 Chinese literatures,5 English literatures;5 randomized controlled trials and 8 retrospective cohort studies.A total of 944 patients with distal fibula fractures were mainly of danis-weber B type,with 469 in the intramedullary fixation group and 475 in the plate fixation group.The results of meta-analysis showed that compared with plate fixation,the operative time of intramedullary fixation was shortened[MD=-15.44,95%ci(-22.31,-8.57,P<0.0001)],the mean operative time of IMF was 37.5 min,and the mean operative time of PF was 53.8 min.Intraoperative blood loss decreased,[MD=-36.41,95%ci(-44.34,-28.49,P<0.00001)],the average intraoperative blood loss of IMF was 28.9ml,and the average intraoperative blood loss of PF was 65.9ml.The surgical incision size was reduced,[MD=-6.87,95%ci(-9.26,-4.48,P<0.00001)],IMF average incision size was 3.7cm,PF average incision size was 10.6cm.Shorter hospital stay,[MD=-6.76,95%ci(-10.59,-2.93,P=0.0005)],the average hospital stay of IMF was 14 days,and the average hospital stay of PF was 21.1 days.The fracture healing time was shortened,[MD=-19.88,95%ci(-29.77,-9.98,P<0.0001)],the average IMF fracture healing time was 67.8 days,and the average PF fracture healing time was 88.7 days.The number of patients complaining about pain and discomfort of internal fixation decreased,[OR=0.06,95%ci(0.02,0.18,P<0.00001)],the proportion of patients complaining about pain of internal fixation after IMF surgery was 3/169,and the proportion of patients complaining about pain of internal fixation after PF surgery was 44/161.The number of patients with internal fixation looseness decreased,[OR=0.27,95%ci(0.11,0.68,P=0.005)],the proportion of patients with fixation looseness after IMF surgery was 4/229,and the proportion of patients with fixation looseness after PF surgery was 20/241.The number of patients infected by surgical incision decreased,[OR=0.1,95%ci(0.05,0.22,P<0.00001)],the proportion of patients infected after IMF surgery was 4/435,and the PF group was 67/449.The rate of good ankle function was higher,[RR=1.12,95%ci(1.04,1.20,P=0.003)],the proportion of patients with excellent postoperative ankle function score by IMF was 259/294,and the PF group was 246/315.The above indexes were statistically significant,and no significant deviation was found in the four indexes of operation time,fracture healing time,surgical incision infection,and excellent function rate of ankle joint.Conclusion According to the included literature and results of meta-analysis,distal fibula fractures with intramedullary fixation compared with plate fixation,can shorten the surgery,hospitalization,fracture healing time,reduce the incision,less blood loss,reduce pain,discomfort,loosening of fracture internal fixation and postoperative infection,improve the good rate of postoperative ankle function score.It provides a reference for the selection of surgical methods for the clinical treatment of distal fibula fracture. |
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