Intramedullary fibular nailing versus open reduction internal fixation for unstable geriatric ankle fractures: A systematic review and meta-analysis.

Introduction: Surgical fixation of ankle fragility fractures presents unique challenges in the elderly. Although the standard fixation technique is open reduction internal fixation (ORIF), intramedullary fibular nailing (IMFN) offers a minimally invasive approach. In this systematic review and meta-analysis, we compare postoperative complication and reintervention rates in geriatric ankle fractures fixed with IMFN versus ORIF. Methods: A systematic review was conducted in MEDLINE (PubMed), Web of Science, EMBASE, Academic Search Premier, ProQuest, Google Scholar, Clinicaltrials.gov, and Cochrane Library to identify studies reporting postoperative outcomes in geriatric ankle fractures fixed with IMFN. Studies which compared postoperative outcomes to ORIF were subject to a quantitative meta-analysis. Results: Thirteen studies were eligible for inclusion with a mean age >65 years. In a pooled analysis of 421 fibular nails, the overall rates of postoperative wound infection, malunion or nonunion, and revision were <5 %. A meta-analysis of five comparative studies revealed no significant difference in the rate of revision, malunion or nonunion, symptomatic hardware, hardware removal, or thrombosis between IMFN (n = 161) and ORIF (n = 374). However, the rate of postoperative wound infections was significantly lower in the IMFN group (RR = 0.34; CI: [0.15, 0.74]; p = 0.007). A subgroup analysis revealed that only the risk of superficial wound infections, and not deep wound infections, was significantly decreased. Conclusions: IMFN is a promising avenue for geriatric ankle fracture fixation and should be considered within the context of individualized patient care plans, particularly in patients at an increased risk of infection.