Intramedullary nail versus plate treatments for distal tibial fractures: A meta-analysis

Yu, Jiwen; Lei-ming, LI; Wang, Tong; Sheng, Luxin; Huo, Yongfeng; Yin, Zhaoyang; Gu, Guangxue; He, Wenbo

doi:10.1016/j.ijsu.2015.02.004

Cited by 32 publications

(15 citation statements)

References 33 publications

(41 reference statements)

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“…Compared with previous meta‐analysis, all of the studies included IMN and plate (ORIF/MIPO), but only Xue et al . performed the subgroup‐analysis about MIPO.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta‐Analysis

Liu

Xue

et al. 2019

Orthopaedic Surgery

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To evaluate the application, safety and efficacy of the patients treated with intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal tibia fractures. Following the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines, we searched databases PubMed, Cochrane library, EMBASE and Web of Science from inception of the database up to 10 October 2018, using the keywords “distal tibia fractures”, “plate”, “intramedullary nailing” and “RCT” to identify randomized clinical trials about distal tibia fractures. The included studies were assessed by two researchers according to the Cochrane risk‐of‐bias criteria. The primary outcome of measurement included operation time, malunion rate, nonunion/delayed union rate, and wound complication. Data analysis was conducted with Review Manager 5.3 software. A total of 10 RCTs involving 911 patients fulfilled the inclusion criteria with 455 patients in the IMN group and 456 patients in the MIPO group. There were no significant differences in radiation time, nonunion or delayed union rate, union time and operation time between the two groups. Patients treated with MIPO had lower incidence of malunion compared with IMN (RR = 1.85, 95%CI: 1.21 to 2.83, P = 1.00), while IMN seemed to have lower surgical incision complications whether in closed or opening fractures (RR = 0.49, 95%CI 0.33 to 0.73, P = 0.43). But in patients classified as 43A, the result of subgroup analysis suggested that there was no significant inwound complication between the two groups. MIPO was superior in preventing malunion compared with IMN, and intramedullary nailing appeared to have lower wound complications. However, in patients with 43A distal tibial fractures, MIPO was more recommended for its prevention of malunion. No matter which method we choose, we should notice and prevent the associated complications.

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“…MIPO is the most preferred method for AO-OTA type 43 C1-C2 intra-articular distal tibial fractures, but there are quite a few studies on the use of IMN. 1 , 3 , 11 , 12 Even though there are many studies comparing IMN and minimally invasive plates in the treatment of extra-articular distal tibial fractures in the literature, 4 , 5 , 6 , 8 , 10 to our knowledge, there is no clinical study comparing intramedullary nail and MIPO in the treatment of simple intra-articular AO-OTA type 43 C1-C2 fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment options for distal tibial fractures remain quite controversial. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Intramedullary nailing, osteosynthesis with plates, and external fixation methods are used. Each method has its own advantages and disadvantages.…”

Section: Introductionmentioning

confidence: 99%

“… 3 External fixators and intramedullary nails are less preferred in practice. 1 , 2 , 3 , 4 MIPO is the most often recommended technique, but studies about intramedullary nailing (IMN) are available for simple intra-articular distal tibial fractures that extend to the joint line. 1 , 3 , 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

“…There are many studies comparing IMN and MIPO for extra-articular distal tibial fractures in the literature. 4 , 5 , 6 , 10 , 13 , 14 However, to our knowledge, so far there is no study comparing IMN with MIPO for AO-OTA type 43 C1-C2 simple intra-articular distal tibial fractures.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2)

Beytemür¹,

Barış²,

Albay³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe aim of this study was to compare midterm functional and radiographic results of minimal invasive plate osteosynthesis (MIPO) with intramedullary nailing (IMN) of simple intra-articular distal tibial fractures (AO-OTA type 43 C1-C2).MethodsSeventy-three simple intra-articular distal tibial fracture patients were evaluated retrospectively. All were treated between 2009 and 2014. The average age of the patients was 40.3 years. Thirty-seven patients were treated with IMN and 36 patients were treated with MIPO. Fibular plate osteosynthesis was applied in 5 cases (13.5%) in the IMN group and in 23 patients (63.9%) in the MIPO group.ResultsFunctional results and complications of IMN and MIPO methods were assessed in 73 patients. The average union time was 16.4 ± 2.7 weeks in the IMN group and 15.2 ± 1.8 weeks in the MIPO group (p = 0.079). The average Olerud-Molander Ankle Score was 87.8 ± 8.1 in the IMN group and 81.5 ± 11.8 in the MIPO group (p = 0.013). Four patients in the IMN group experienced valgus malunion, while it was not observed in any patients in the MIPO group (p = 0.042). Recurvatum malunion was detected in 10 patients in the MIPO group and not seen in the IMN group (p = 0.001). Ankle dorsiflexion angle was 25.8 ± 4.5° in the IMN group and 33.3 ± 8.9° in the MIPO group (p = 0.000).ConclusionSimple intra-articular distal tibial fractures are successfully treated with IMN and MIPO. Prevalence of valgus malunion was higher in the IMN group and recurvatum was more prevalent in the MIPO group. MIPO is the first preference according to the literature; however, successful results have been obtained with IMN in this fracture pattern.Level of EvidenceLevel III, Therapeutic Study.

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Intramedullary nail versus plate treatments for distal tibial fractures: A meta-analysis

Abstract: For distal tibial fractures treatment, IMN might be advantageous over plate with lower SI incidence, and comparable UT, OT and HT. Meanwhile, IMN was related to higher risk of malunion. However, more RCTs are warranted.

Cited by 32 publications

References 33 publications

Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta‐Analysis

Comparison of intramedullary nailing and minimal invasive plate osteosynthesis in the treatment of simple intra-articular fractures of the distal tibia (AO-OTA type 43 C1-C2)

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