Posterior-anterior versus anterior-posterior screws for posterior malleolar fractures: A meta-analysis.

IF 1.4 4区医学 Q4 ENGINEERING, BIOMEDICAL

Technology and Health Care Pub Date : 2025-01-01 DOI:10.3233/THC-240602

Chunlin Liu, Chungui Huang

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引用次数: 0

Abstract

Background: The incidence of posterior malleolus fractures in ankle fractures ranges from 7% to 44%. Studies have indicated a poorer prognosis for ankle joint function when a posterior malleolar fracture is present, underscoring the significance of active intervention for optimal postoperative ankle function recovery. Hence, the selection of treatment for such fractures holds particular importance.

Objective: Screw fixation is a key treatment for posterior malleolus fractures (PMFs) or Haraguchi Type 1 fractures involving less than 25% of the distal tibia's articular surface. However, the optimal screw placement direction - anteroposterior (AP) or posterior-anterior (PA) - remains debated. This meta-analysis aims to compare these two approaches for treating posterior ankle fractures, focusing on the efficacy of PA fixation.

Methods: We searched the Cochrane Library, EMBASE, PubMed, SinoMed, and Web of Science databases from their inception to October 20, 2022. Methodological quality was assessed using the Cochrane Collaboration's tool for assessing bias risk in randomized controlled trials (RCTs). Stata MP17 software was used to compare the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, full weight-bearing time, and fracture healing time at the last follow-up between the two fixation methods.

Results: A total of 403 patients with posterior malleolar fractures from six RCTs met the inclusion criteria. The meta-analysis revealed a higher AOFAS score at the last follow-up for PA placement compared to AP placement [SMD = 0.512, 95% CI (0.244 to 0.780), z= 3.74, P< 0.001]. Postoperative full weight-bearing time and fracture healing time did not show statistically significant differences between the two groups.

Conclusion: PA fixation demonstrated a superior AOFAS score compared to AP fixation for posterior malleolar fractures. PA screw placement offers advantages in restoring ankle joint stability and enhancing joint function recovery post-surgery.

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后臼齿骨折的前后螺钉治疗与前后螺钉治疗：荟萃分析

背景：踝关节骨折中后踝骨骨折的发生率为 7% 至 44%。研究表明，后踝臼骨骨折时，踝关节功能的预后较差，这凸显了积极干预对术后踝关节功能恢复的重要性。因此，选择此类骨折的治疗方法尤为重要：螺钉固定是治疗胫骨远端关节面小于 25% 的后踝骨折（PMF）或原口 1 型骨折的主要方法。然而，最佳的螺钉放置方向--前胸（AP）或后前（PA）--仍存在争议。本荟萃分析旨在比较这两种治疗后踝骨折的方法，重点关注 PA 固定的疗效：方法：我们检索了 Cochrane Library、EMBASE、PubMed、SinoMed 和 Web of Science 数据库中从开始到 2022 年 10 月 20 日的内容。采用 Cochrane 协作组织的随机对照试验（RCT）偏倚风险评估工具对方法学质量进行了评估。使用Stata MP17软件比较两种固定方法的美国骨科足踝协会（AOFAS）踝关节-后足评分、完全负重时间和最后一次随访时的骨折愈合时间：共有来自六项研究的403名踝后骨折患者符合纳入标准。荟萃分析显示，与 AP 置入法相比，PA 置入法在最后一次随访时的 AOFAS 得分更高[SMD = 0.512，95% CI (0.244 to 0.780)，z= 3.74，P< 0.001]。两组患者术后完全负重时间和骨折愈合时间的差异无统计学意义：结论：与 AP 固定相比，PA 固定治疗后踝骨骨折的 AOFAS 评分更高。PA螺钉置入术在恢复踝关节稳定性和提高术后关节功能恢复方面具有优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Technology and Health Care HEALTH CARE SCIENCES & SERVICES-ENGINEERING, BIOMEDICAL

CiteScore

2.10

自引率

6.20%

发文量

282

审稿时长

>12 weeks

期刊介绍： Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured. The main focus of THC is related to the overlapping areas of engineering and medicine. The following types of contributions are considered: 1.Original articles: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine. In particular, the clinical benefit deriving from the application of engineering methods and devices in clinical medicine should be demonstrated. Typically, full length original contributions have a length of 4000 words, thereby taking duly into account figures and tables. 2.Technical Notes and Short Communications: Technical Notes relate to novel technical developments with relevance for clinical medicine. In Short Communications, clinical applications are shortly described. 3.Both Technical Notes and Short Communications typically have a length of 1500 words. Reviews and Tutorials (upon invitation only): Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented. The Editorial Board is responsible for the selection of topics. 4.Minisymposia (upon invitation only): Under the leadership of a Special Editor, controversial or important issues relating to health care are highlighted and discussed by various authors. 5.Letters to the Editors: Discussions or short statements (not indexed).