Title : Fibula nail fixation versus Open Reduction and Internal Fixation (ORIF) for distal fibula fractures
Abstract:
Introduction: Fibular fractures, particularly those involving the distal fibula, are commonly treated with Open Reduction and Internal Fixation (ORIF). However, Intra Medullary (IM) nailing has emerged as an alternative, particularly in patients at risk of wound complications.
Aims and Objectives: This systematic review evaluates the efficacy, safety and biomechanical advantages of IM nailing as compared to ORIF.
Methods: A systematic literature search was conducted using PubMed, EMBASE, and Cochrane databases. Studies comparing IM nailing with plating for fibular fractures were included. Outcomes assessed included union rates, complication rates, functional outcomes, and time to weight-bearing.
Results: A total of 10 studies were included, incorporating 1,580 patients. Union rates for IM nailing were 98.6% as compared to 97.2% for ORIF. Complication rates were significantly lower with IM nailing (14%) versus ORIF (29%), particularly in terms of wound infections and hardware irritation. Functional outcome scores, including American Orthopaedic Foot and Ankle Society (AOFAS) and Olerud-Molander scores, were comparable or slightly better in the IM nailing cohort. IM nailing allowed for earlier weight-bearing and had fewer secondary surgical interventions.
Conclusion: IM fibular nailing is a viable alternative to ORIF, offering reduced soft tissue complications, earlier rehabilitation and comparable union rates. Future randomized controlled trials are warranted to further delineate patient selection criteria and long-term functional outcomes.
Keywords: Fibula nail fixation, ORIF, distal fibula fractures
