Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis

Abstract

BackgroundThe choice between intramedullary (IM) nailing or plating of distal tibia fractures without articular involvement remains controversial. A meta-analysis of randomized controlled trials (RCTs) and observational studies was performed to compare IM nailing with plating for distal tibia fractures without articular involvement and to determine the dominant strategy.Materials and methodsThe PubMed, Embase, Cochrane Library databases, Chinese Wan-Fang Database, and China National Knowledge Infrastructure were searched.ResultsTwenty-eight studies, which included 1863 fractures, met the eligible criteria. The meta-analysis did not identify a statistically significant difference between the two treatments in terms of the rate of deep infection, delayed union, removal of instrumentation, or secondary procedures either in the RCT or retrospective subgroups. IM nailing was associated with significantly more malunion events and a higher incidence of knee pain in the retrospective subgroup and across all the studies, but not significantly in the RCT subgroup, and a lower rate of delayed wound healing and superficial infection both in the RCT and retrospective subgroups relative to plating. A meta-analysis of the functional scores or questionnaires was not possible because of the considerable variation among the included studies, and no significant differences were observed.ConclusionsEvidence suggests that both IM nailing and plating are appropriate treatments as IM nailing shows lower rate of delayed wound healing and superficial infection and plating may avoid malunion and knee pain. These findings should be interpreted with caution, however, because of the heterogeneity of the study designs. Large, rigorous RCTs are required.

Staged treatment of an intra-articular fracture of the distal tibia with a modified intramedullary nail (case study)

“…A significant part of the literature is devoted to the techniques of intramedullary osteosynthesis of extra-articular tibial fractures [17]. In some cases, authors that used IMO for fixation of metaphyseal fractures admit that a fracture line extending from the metaphysis to the articular surface without impression of the latter (fracture type 43 B1) can be considered as a fracture type 43A and, accordingly, be treated in a similar way [18 ].…”

A comparison of the cost-effectiveness of intramedullary nail fixation and locking plate fixation in the treatment of adult patients with an extra-articular fracture of the distal tibia

“…Beyond the 12-month follow-up period assessed in this study, rehospitalisation and reoperation are possible due to excess complications [3] . We conducted a preliminary analysis of the extended follow-up data for this trial to determine whether differences in HRQoL outcomes, metalwork removal and in rates of complications persisted at 24 months.…”

“…Evidence from previous meta-analyses and systematic reviews comparing nailing versus plating treatment modalities have been inconclusive. Mao et al reviewed 1863 extra-articular fractures of the distal tibia [3] . They reported that rates of deep infection, delayed union and removal of instrumentation were similar for patients undergoing nail and plate fixation, but nail fixation was associated with significantly more mal-unions.…”

“…In contrast, Zelle et al found that mal-union rates were similar between the two treatment groups [4] . However, the studies included in the metaanalyses had heterogeneous study designs and the randomised controlled trials lacked methodologic rigour [3] .…”

Intramedullary Nailing of Periarticular Fractures

“…Meta-analyses and systematic reviews comparing plate and nail fixation of distal tibia fractures have yielded limited information to guide treatment. [34][35][36] Two RCTs found no difference in functional outcome between plates and nails for distal tibia fractures. 28,37 Two RCTs demonstrated a lower rate of wound complications and superficial infection with IMN.…”