Comparative study of different fixation methods for osteosynthesis of ankle fractures: clinical outcomes and bone consolidation rates

Abstract

Objective: To describe and analyze the evidence on the effectiveness of different fixation methods for osteosynthesis of ankle fractures, highlighting clinical outcomes and bone consolidation rates. Methods: This study is a systematic literature review conducted to gather and evaluate the available evidence on different fixation methods for osteosynthesis of ankle fractures. The PubMed, Scopus, Web of Science, Cochrane Library, and Virtual Health Library (VHL) databases were used. We included studies published in the last 10 years, available in full text, and in English, Portuguese, or Spanish that compared fixation methods. Screening was performed by two independent reviewers in two stages (titles/abstracts and complete evaluation). A third reviewer resolved disagreements. Extracted data included population, interventions, outcomes, and conclusions. Results: The analysis included studies published in the last 10 years, encompassing diverse populations and methodologies. The results indicate that the choice of fixation method should consider not only functional outcomes, but also fracture severity and pattern. Intramedullary fixation has shown advantages in less complex fractures and in patients at higher risk of infectious complications. Plate fixation remains the technique of choice in complex fractures, although it is associated with higher complication rates in patients with comorbidities and older patients. The use of external fixators, in turn, is indicated for extensive soft-tissue injuries or as a temporary measure before definitive surgery. Conclusion: The choice of fixation method should be individualized, considering the severity of the fracture, the patient’s clinical status, and any associated complications. Intramedullary fixation tends to be more favorable in simple cases, while plate fixation is indicated for complex fractures. External fixators remain an important option in specific situations. Level of Evidence II; Systematic Review