Intramedullary nail versus plate for distal tibial shaft fractures in adults: a Meta-analysis

Abstract

Objective To systematically compare the related complications of distal tibial shaft fractures in adults treated by intramedullary nails and plates.Methods According to the methods of systematic review of Cochrane,we searched for articles comparing intramedullary nail and plate for distal tibial shaft fractures in adults in MEDLINE (from 1966 to March 2012),EMbase databases (from 1974 to March2012),Cochrane library,CBM discs (from 1979 to March 2012) and the relevant Chinese and English orthopedic journals.All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were included for the present study.The total complications,infections,malunion,nonunion,delayed union and secondary operation were chosen as evaluation indexes for the present Meta-analysis.The system review was performed using the method recommended by the Cochrane Collaboration.Results Three RCTs and 4 CCTs with a total of 463 patients were included (258 in the intramedullary nail group and 205 in the plate group).Compared with the plate treatment,intramedullary nail significantly increased the risk of malunion[RR =3.81,95％ CI(2.01,7.21 ),P ＜ 0.05].There were no statistically significant differences regarding total complications[RR =1.46,95％ CI(0.90,2.38),P =0.12],infection[RR =0.54,95％ CI(0.27,1.07),P =0.08],nonunion[RR=1.74,95％CI(0.62,4.90),P=0.30],delayed union[RR=2.03,95％CI (0.56,7.31),P =0.28]and secondary operation[RR =1.22,95％ CI(0.71,2.10),P =0.47]between the 2 groups.Conclusion Since intramedullary nail may significantly increase the risk of malunion,the plate may be a better choice for distal tibial shaft fractures in adults. Key words: Tibial fractures; Bone nails; Bone plates; Meta-analysis