title: Intrmedullary versus extramedullary fixation of lateral malleolus fractures.
abstract: BACKGROUND
  Intramedullary nails (IM nails) now include dedicated fibular nails for lateral malleolus fractures. This study reviewed nail versus plate for fixation of unstable ankle fractures.
  
  
  METHODS
  Systematic review and meta-analysis of published reports.
  
  
  RESULTS
  Four studies met the inclusion criteria, including 375 patients. Two included studies were randomised-control studies and two were non-randomised case series. The implants investigated included: Knowles Pins, Fibular Nails, Rush Rods and Inyo Nails. The overall risk of bias was high. Pooled data showed a statistically significant lower risk of wound infection (RR 0.10; 95% CI 0.02 to 0.44), symptomatic hardware (RR 0.14; 95% CI 0.05 to 0.35) and removal of hardware (RR 0.57; 95% CI 0.39 to 0.81) with intramedullary nail fixation.
  
  
  CONCLUSIONS
  There is a paucity of literature upon which to draw reliable conclusions. There was a high risk of bias towards favourable outcomes for the nail group. It would appear that intramedullary nail fixation of distal fibular fractures can outperform conventional fixation with plate and screws. There is a need for adequately powered, scientific trials.
authors.affiliation: Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK. Electronic address: haroon.rehman.06@aberdeen.ac.uk.
authors.forename: Haroon
authors.initials: H
authors.lastname: Rehman
authors.affiliation: Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK.
authors.forename: Tristan
authors.initials: T
authors.lastname: McMillan
authors.affiliation: University of Edinburgh, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Rehman
authors.affiliation: Aberdeen Royal Infirmary, Foresterhill, Aberdeen, AB25 2ZN, UK.
authors.forename: Adeline
authors.initials: A
authors.lastname: Clement
authors.affiliation: Old Perth Road, Inverness, Inverness-shire IV2 3UJ, UK.
authors.forename: David
authors.initials: D
authors.lastname: Finlayson
mesh_terms: D064386:Ankle Fractures / Q000601:surgery*; D001858:Bone Nails; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans
keywords: Fibula; Fracture; Intramedullary; Lateral malleolus; Nail