Percutaneous vs. open screw fixation for medial malleolus fractures: a systematic review and meta-analysis of randomized controlled trials
- 1Department of Orthopedics, Quzhou Hospital of Traditional Chinese Medicine, Quzhou TCM Hospital at the Junction of Four Provinces Affiliated to Zhejiang Chinese Medical University, Quzhou, Zhejiang, China
- 2Quzhou Municipal Health Commission, Quzhou, Zhejiang, China
- 3The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, China
Abstract
IntroductionOpen reduction and internal fixation with screws remains a commonly employed surgical technique for displaced medial malleolus fractures. Closed reduction and percutaneous fixation has emerged as a potentially less invasive alternative; however, the comparative effectiveness of these two approaches has not been established by high-level evidence. This meta-analysis was conducted to compare the clinical outcomes of closed reduction and percutaneous screw fixation (CRPF) versus open reduction and internal screw fixation (ORIF) in patients with isolated medial malleolus fractures.MethodsPubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were searched from inception to June 15, 2026, for randomized controlled trials. Quality assessment was performed using the Cochrane RoB 2.0 tool. Meta-analyses were conducted using RevMan 5.4, with mean differences or odds ratios pooled using fixed- or random-effects models depending on heterogeneity.ResultsSix randomized controlled trials comprising 366 patients (183 in the CRPF group and 183 in the ORIF group) were included. Compared with ORIF, CRPF was associated with significantly shorter operative time (MD −17.19 min, 95% CI −26.11 to −8.27; I2 = 98%) and faster fracture healing (MD −2.19 weeks, 95% CI −3.08 to −1.30; I2 = 71%). Kofoed scores were significantly higher in the CRPF group (MD 8.26 points, 95% CI 0.47 to 16.05; I2 = 88%), whereas no significant difference was observed in the excellent/good outcome rate (OR 1.88, 95% CI 0.37 to 9.44; I2 = 73%). The overall complication rate was significantly lower in the CRPF group (OR 0.21, 95% CI 0.09 to 0.46; I2 = 19%). No significant between-group difference was detected in AOFAS scores (MD 7.32 points, 95% CI −2.85 to 17.50; I2 = 92%). Risk-of-bias assessment using the Cochrane RoB 2 tool identified five studies as having some concerns and one study as having a high risk of bias for functional outcomes.ConclusionsCRPF was associated with shorter operative time, earlier fracture healing, and a lower overall postoperative complication rate than ORIF in patients with isolated medial malleolar fractures. However, improvements in functional outcomes were not consistently demonstrated across different assessment measures. CRPF represents a viable alternative to ORIF in appropriately selected patients, particularly when satisfactory closed reduction can be achieved. Further well-designed randomized controlled trials are needed to establish its long-term functional benefits.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261422946, PROSPERO CRD420261422946.
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BibTeX
@article{wu2026percutaneous,
title = {{Percutaneous vs. open screw fixation for medial malleolus fractures: a systematic review and meta-analysis of randomized controlled trials}},
author = {Fan Wu and Jiaying Shao and Chuanxiao Hu},
journal = {Frontiers in Surgery},
year = {2026},
month = nov,
doi = {10.3389/fsurg.2026.1917590},
url = {https://doi.org/10.3389/fsurg.2026.1917590},
note = {CC BY},
}
RIS
TY - JOUR
TI - Percutaneous vs. open screw fixation for medial malleolus fractures: a systematic review and meta-analysis of randomized controlled trials
AU - Fan Wu
AU - Jiaying Shao
AU - Chuanxiao Hu
PY - 2026
DA - 2026/11/09
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1917590
UR - https://doi.org/10.3389/fsurg.2026.1917590
AB - IntroductionOpen reduction and internal fixation with screws remains a commonly employed surgical technique for displaced medial malleolus fractures. Closed reduction and percutaneous fixation has emerged as a potentially less invasive alternative; however, the comparative effectiveness of these two approaches has not been established by high-level evidence. This meta-analysis was conducted to compare the clinical outcomes of closed reduction and percutaneous screw fixation (CRPF) versus open reduction and internal screw fixation (ORIF) in patients with isolated medial malleolus fractures.MethodsPubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were searched from inception to June 15, 2026, for randomized controlled trials. Quality assessment was performed using the Cochrane RoB 2.0 tool. Meta-analyses were conducted using RevMan 5.4, with mean differences or odds ratios pooled using fixed- or random-effects models depending on heterogeneity.ResultsSix randomized controlled trials comprising 366 patients (183 in the CRPF group and 183 in the ORIF group) were included. Compared with ORIF, CRPF was associated with significantly shorter operative time (MD −17.19 min, 95% CI −26.11 to −8.27; I2 = 98%) and faster fracture healing (MD −2.19 weeks, 95% CI −3.08 to −1.30; I2 = 71%). Kofoed scores were significantly higher in the CRPF group (MD 8.26 points, 95% CI 0.47 to 16.05; I2 = 88%), whereas no significant difference was observed in the excellent/good outcome rate (OR 1.88, 95% CI 0.37 to 9.44; I2 = 73%). The overall complication rate was significantly lower in the CRPF group (OR 0.21, 95% CI 0.09 to 0.46; I2 = 19%). No significant between-group difference was detected in AOFAS scores (MD 7.32 points, 95% CI −2.85 to 17.50; I2 = 92%). Risk-of-bias assessment using the Cochrane RoB 2 tool identified five studies as having some concerns and one study as having a high risk of bias for functional outcomes.ConclusionsCRPF was associated with shorter operative time, earlier fracture healing, and a lower overall postoperative complication rate than ORIF in patients with isolated medial malleolar fractures. However, improvements in functional outcomes were not consistently demonstrated across different assessment measures. CRPF represents a viable alternative to ORIF in appropriately selected patients, particularly when satisfactory closed reduction can be achieved. Further well-designed randomized controlled trials are needed to establish its long-term functional benefits.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261422946, PROSPERO CRD420261422946.
SN - 2296-875X
ER -