Efficacy of Percutaneous Cannulated Screw versus Plate Fixation for Ankle Fractures: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 SONGJian , LIZong-huan ,  YUAi-xi , QIBai-wen , XIAOWei-dong , WANGWei-yang , YIWan-rong , LIUDeng-cheng , ZefaniasCarlos P

Department of Orthopedics, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China;

Corresponding?author：

YUAi-xi, Email: yuaixi666@163.com

Keywords：

Percutaneous cannulated screw; Plate fixation; Ankle fracture; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20150056

Video：

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Objective To systematically review the efficacy of percutaneous cannulated screw (PCS) versus plate fixation (PF) in the treatment of ankle fractures. Methods The Cochrane Library (Issue 5, 2014), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched up to May 28th 2014, for studies concerning the efficacy of percutaneous cannulated screw versus plate fixation for ankle fractures. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. Result A total of 10 studies (3 RCTs and 7 CCTs) involving 627 patients were included. The results of meta-analysis showed that:compared with the PF group, the PCS group was superior in time of the operation (RCT:MD=-6.78, 95%CI -11.95 to -1.60, P=0.01; CCT:MD=-9.76, 95%CI -13.68 to -5.84, P<0.000 01), blood loss during the operation (RCT:MD=-36.14, 95%CI -40.02 to -32.17, P<0.000 01; CCT:MD=-34.80, 95%CI -37.78 to -31.81, P<0.000 01) and the time of the fracture healing (RCT:MD=-1.16, 95%CI -1.51 to -0.81, P<0.000 01; CCT:MD=-1.55, 95%CI -2.97 to -0.13, P=0.03); However, there were no statistical differences between the two groups in complication rate (CCT:OR=0.48, 95%CI 0.08 to 2.81, P=0.41), AOFAS score excellent rate (RCT:OR=2.11, 95%CI 0.81 to 5.49, P=0.12; CCT:OR=1.58, 95%CI 0.75 to 3.30, P=0.23), and postoperative malleolus pain rate (CCT:OR=0.68, 95%CI 0.00 to 148.82, P=0.89). Conclusion Current evidence shows that PCS is superior to PF in shorting time of the operation, reducing blood loss during the operation, and shorting time of the fracture healing. However, the complication rate, AOFAS score excellent rate, and postoperative malleolus pain rate are similar for each operation. Due to the quality limitation of the CCTs, the conclusion are needed to be verified by more high quality RCTs in future.

Citation： SONGJian, LIZong-huan, YUAi-xi, QIBai-wen, XIAOWei-dong, WANGWei-yang, YIWan-rong, LIUDeng-cheng, ZefaniasCarlos P. Efficacy of Percutaneous Cannulated Screw versus Plate Fixation for Ankle Fractures: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(3): 335-341. doi: 10.7507/1672-2531.20150056 Copy

1.	Toolan BC, Wright QV, Cunningham BJ, et al. An evaluation of the use of retrospectively acquired preoperative AOFAS clinical rating scores to assess surgical outcome after elective foot and ankle surgery. Foot Ankle Int, 2001, 22 (10):775-778.
2.	Harper MC. Ankle fracture classification systems:a case for integration of the Lauge-Hansen and AO-Danis-Weber schemes. Foot Ankle, 1992, 13 (7):404-407.
3.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at:http://www.cochrane-handbook.org.
4.	Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors):development and validation of a new instrument. ANZ J Surg, 2003, 73(9):712-716.
5.	馮青, 許效坤, 曹希武, 等. 2 種內固定方法治98例踝關節骨折的療效比較. 中國微創外科雜志, 2012, 12(2):168-174.
6.	易平, 張戰和, 李海濤. 不同內固定方法治療踝關節骨折的療效比較. 中國醫學創新, 2012, 9(35):39-40.
7.	孫龍. 踝關節骨折閉合復位內固定的臨床療效分析大連醫科大學碩士畢業論文, 2013-04-13.
8.	潘波, 張曉彬. 經皮加壓空心螺釘內固定在踝關節骨折的治療應用. 中國傷殘醫學, 2014, 22(6):72-73.
9.	滕軍. 經皮加壓空心螺釘內固定在踝關節骨折中的治療應用.當代醫學, 2013, 19(5):96-97.
10.	雷磊, 楊鐵毅, 王治, 等. 空心釘與鋼板治療后踝骨折臨床療效對比分析. 寧夏醫科大學學報, 2012, 34(8):783-785.
11.	葉繼輝. 微創治療后踝骨骨折的臨床觀察. 中國醫學創新, 2013, 10(27):129-130.
12.	Yang SW, Tzeng HM, Chou YJ, et al. Treatment of distal tibial metaphyseal fractures:Plating versus shortened intramedullary nailing. Injury, 2006, 37(6):531-535.
13.	Asloum Y, Bedin B, Roger T, et al. Internal fixate on of the fibula in ankle fractures. A prospective randomized and comparative study:Plating versus nailing. Orthopaedics & Traumatology, 2014, 100(2):255-259.
14.	Kasper W, Janssen JB, Albert VK. Treatment of distal tibial fractures:plate versus nail. International Orthopaedics, 2007, 31(5):709-714.
15.	McKinley TO, Rudert MJ, Koos DC, et al. Incongruity versus instability in the etiology of posttraumatic arthritis. Clin Orthop Relat Res, 2004, 2(3):44-51.
16.	Benthien RA, Myerson MS. Supramalleolar osteotomy for ankle deformity and arthritis. Foot Ankle Clin, 2004, 9(3):475-487.
17.	Kara AN, Esenyel CK, Sener BT, et al. A different approach to the treatment of the lateral malleolar fractures with syndesmosis injury:the ANK Nail. Foot Ankle Surg, 1999, 38(5):394-402.
18.	Kabukcuoglu Y, Kucukkaya M, Eren T, et al. The ANK device:a new approachin the treatment of the fractures of the lateral malleolus associated with therupture of the syndesmosis. Foot Ankle Int, 2000, 21(4):753-758.
19.	Ramasamy PR, Sherry P. The role of a fibular nail in the management of Weber type B ankle fractures in elderly patients with osteoporotic bone. Injury, 2001, 32(10):477-485.
20.	Appleton P, McQueen M, Court-Brown C. The fibula nail for treatment of ankle fractures in elderly and high risk patients. Tech Foot Ankle, 2006, 5(12):204-208.
21.	Im GI, Tae SK. Distal metaphyseal fractures of tibia:a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. Trauma, 2005, 59(5):1219-1223.
22.	Kim SK, Oh JK. One or two lag screw for fixation of Dalnis-Weber type B fractures of the ankle. J Trauma, 1999, 46(5):1039-1140.
23.	Hu LY, Jia QY, Zheng SQ, et al. Treatment of fracture of fifth metatarsal base and degree Ⅲ lateral ligament injury of ankle with compressed cannulated screw and suture anchors. China Journal of Orthopaedics and Traumatology, 2013, 26 (7):608-611.
24.	Kose KC, Cebesoy O, Ozcakar L. Is screw augmentation necessary in ankle fractures? G. Andreassen, et al. "The use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation." Arch Orthop Trauma Surg, 2004, 124(8):574.
25.	Rudiger HA, Kang KJ, Sindram D, et al. Comparison of ischemic preconditioning and intermittent and continuous inflow occlusion in the murine liver. Ann Surg, 2002, 235(3):400-407.

1. Toolan BC, Wright QV, Cunningham BJ, et al. An evaluation of the use of retrospectively acquired preoperative AOFAS clinical rating scores to assess surgical outcome after elective foot and ankle surgery. Foot Ankle Int, 2001, 22 (10):775-778.
2. Harper MC. Ankle fracture classification systems:a case for integration of the Lauge-Hansen and AO-Danis-Weber schemes. Foot Ankle, 1992, 13 (7):404-407.
3. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0). Available at:http://www.cochrane-handbook.org.
4. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (minors):development and validation of a new instrument. ANZ J Surg, 2003, 73(9):712-716.
5. 馮青, 許效坤, 曹希武, 等. 2 種內固定方法治98例踝關節骨折的療效比較. 中國微創外科雜志, 2012, 12(2):168-174.
6. 易平, 張戰和, 李海濤. 不同內固定方法治療踝關節骨折的療效比較. 中國醫學創新, 2012, 9(35):39-40.
7. 孫龍. 踝關節骨折閉合復位內固定的臨床療效分析大連醫科大學碩士畢業論文, 2013-04-13.
8. 潘波, 張曉彬. 經皮加壓空心螺釘內固定在踝關節骨折的治療應用. 中國傷殘醫學, 2014, 22(6):72-73.
9. 滕軍. 經皮加壓空心螺釘內固定在踝關節骨折中的治療應用.當代醫學, 2013, 19(5):96-97.
10. 雷磊, 楊鐵毅, 王治, 等. 空心釘與鋼板治療后踝骨折臨床療效對比分析. 寧夏醫科大學學報, 2012, 34(8):783-785.
11. 葉繼輝. 微創治療后踝骨骨折的臨床觀察. 中國醫學創新, 2013, 10(27):129-130.
12. Yang SW, Tzeng HM, Chou YJ, et al. Treatment of distal tibial metaphyseal fractures:Plating versus shortened intramedullary nailing. Injury, 2006, 37(6):531-535.
13. Asloum Y, Bedin B, Roger T, et al. Internal fixate on of the fibula in ankle fractures. A prospective randomized and comparative study:Plating versus nailing. Orthopaedics & Traumatology, 2014, 100(2):255-259.
14. Kasper W, Janssen JB, Albert VK. Treatment of distal tibial fractures:plate versus nail. International Orthopaedics, 2007, 31(5):709-714.
15. McKinley TO, Rudert MJ, Koos DC, et al. Incongruity versus instability in the etiology of posttraumatic arthritis. Clin Orthop Relat Res, 2004, 2(3):44-51.
16. Benthien RA, Myerson MS. Supramalleolar osteotomy for ankle deformity and arthritis. Foot Ankle Clin, 2004, 9(3):475-487.
17. Kara AN, Esenyel CK, Sener BT, et al. A different approach to the treatment of the lateral malleolar fractures with syndesmosis injury:the ANK Nail. Foot Ankle Surg, 1999, 38(5):394-402.
18. Kabukcuoglu Y, Kucukkaya M, Eren T, et al. The ANK device:a new approachin the treatment of the fractures of the lateral malleolus associated with therupture of the syndesmosis. Foot Ankle Int, 2000, 21(4):753-758.
19. Ramasamy PR, Sherry P. The role of a fibular nail in the management of Weber type B ankle fractures in elderly patients with osteoporotic bone. Injury, 2001, 32(10):477-485.
20. Appleton P, McQueen M, Court-Brown C. The fibula nail for treatment of ankle fractures in elderly and high risk patients. Tech Foot Ankle, 2006, 5(12):204-208.
21. Im GI, Tae SK. Distal metaphyseal fractures of tibia:a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. Trauma, 2005, 59(5):1219-1223.
22. Kim SK, Oh JK. One or two lag screw for fixation of Dalnis-Weber type B fractures of the ankle. J Trauma, 1999, 46(5):1039-1140.
23. Hu LY, Jia QY, Zheng SQ, et al. Treatment of fracture of fifth metatarsal base and degree Ⅲ lateral ligament injury of ankle with compressed cannulated screw and suture anchors. China Journal of Orthopaedics and Traumatology, 2013, 26 (7):608-611.
24. Kose KC, Cebesoy O, Ozcakar L. Is screw augmentation necessary in ankle fractures? G. Andreassen, et al. "The use of a synthetic bone void filler to augment screws in osteopenic ankle fracture fixation." Arch Orthop Trauma Surg, 2004, 124(8):574.
25. Rudiger HA, Kang KJ, Sindram D, et al. Comparison of ischemic preconditioning and intermittent and continuous inflow occlusion in the murine liver. Ann Surg, 2002, 235(3):400-407.

Chinese Journal of Evidence-Based Medicine

Efficacy of Percutaneous Cannulated Screw versus Plate Fixation for Ankle Fractures: A Meta-analysis

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