Comparison of intramedullary nailing fixation and percutaneous locked plating fixation for the treatment of proximal tibial fractures: A meta-analysis

Abstract

Objective: This meta-analysis aimed to systematically compare the clinical outcomes of intramedullary nailing (IMN) fixation and percutaneous locked plating (PLP) fixation in the treatment of proximal tibial fractures. Methods: We searched PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and Wan Fang to select relevant articles up to March 29, 2020 without language limit. Continuous variables were estimated by weighted mean difference (WMD) with a 95% confidence interval (CI) and dichotomous outcomes were calculated by relative risk (RR) with 95% CI. Moreover, heterogeneity analysis was evaluated. Furthermore, publication bias assessment and sensitivity analysis were conducted. Stata 11.0 software was used to perform the statistical analysis. Results: Ten studies involving 667 cases (321 from IMN fixation group and 346 from PLP fixation group) were included. The type of fractures involved in the included articles was extra-articular proximal tibia fractures. IMN fixation method achieved significantly shorter union time ( WMD = −2.88, 95% CI: −3.23 to −2.53, p < 0.001) and full weight-bearing time ( WMD = −2.81, 95% CI: −3.64 to −1.97, p < 0.001) than PLP fixation method. Meanwhile, IMN fixation resulted in lower risks of infection ( RR = 0.50, 95% CI: 0.27 to 0.91, p = 0.02) and total complications ( RR = 0.36, 95% CI: 0.22 to 0.60, p < 0.001) than PLP fixation. No significant differences were found in the incidence of nonunion ( p = 0.33), malunion ( p = 0.38), and osteofascial compartment syndrome (OCS, p = 0.62) between the two groups. Conclusions: Compared to PLP fixation, IMN fixation had several advantages in treating proximal tibial fractures, including the short time of union and full weight-bearing, as well as a low risk of infection and total complications.

Combined Medial Plate and Intramedullary Nailing for the Fixation of Extra-Articular Proximal Tibial Fractures: a Biomechanics Study

“…Although typing of fractures can guide decision-making, implant selection is often based on the preferences of orthopedic surgeons. Our previous study revealed that IMN for proximal tibia fractures is associated with a shorter time of union, full weight-bearing, a low risk of infection, and fewer total complications than plating fixation ( Ren et al, 2021 ). Moreover, some authors reported an alternative fixation option for intramedullary fracture fixation by elastic nailing recently, according to previous study when synthesis devices are too stiff the bone is not properly stimulated and healing is delayed, therefore the numerical elastic self-locking nail maybe another better fixation option ( Putame et al, 2020 ).…”

“…In recent years, as orthopedic surgeons have become more aware of the importance of the soft tissues and the bone blood, IMN has become a more common fixation method for proximal tibia fractures ( Baker et al, 2021 ). Our previous meta-analysis on ten studies involving 667 patients revealed that IMN for proximal tibia fractures is associated with a shorter time of union, full weight-bearing, a low risk of infection, and fewer total complications than those for plating fixation ( Ren et al, 2021 ). Due to the particularity of the proximal tibial anatomy, the problems of poor reduction and malunion can easily occur when fixed with the IMN ( Nork et al, 2006 ).…”

Do Long-Segment Blocking Screws Increase the Stability of Intramedullary Nail Fixation in Proximal Tibia Fractures, Eliminating the “Bell-Clapper Effect?”

“…3 IMN of proximal tibia fractures is technically demanding, 4 but offers benefits such as the potential for immediate weightbearing 5 and decreased soft tissue disruption. 6–9…”

“…3 IMN of proximal tibia fractures is technically demanding, 4 but offers benefits such as the potential for immediate weightbearing 5 and decreased soft tissue disruption. [6][7][8][9] The optimal surgical treatment for extra-articular fractures of the proximal tibia has not been determined. 3,[6][7][8][9][10] Previous biomechanical studies comparing intramedullary versus extramedullary constructs for the fixation of proximal tibia fractures have demonstrated noninferiority to slight superiority of IMN.…”

“…[6][7][8][9] The optimal surgical treatment for extra-articular fractures of the proximal tibia has not been determined. 3,[6][7][8][9][10] Previous biomechanical studies comparing intramedullary versus extramedullary constructs for the fixation of proximal tibia fractures have demonstrated noninferiority to slight superiority of IMN. 6,8,10 Clinical comparisons of IMN versus plating have demonstrated no significant differences, with trends toward higher malunion and lower infection rates with IMN.…”