Abstract
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.
Highlights
Distal tibia fractures occurred in patients commonly as a result of a force directed from the foot towards the leg in high energy traumatic events, such as falling down, traffic accident, motorcycle accident, or sport injury[1]
Characteristics of Included Studies A total of 911 patients with distal tibial fractures were included in the meta-analysis, with patients who underwent intramedullary nailing and patients who were treated with minimally invasive plate osteosynthesis (MIPO)
Our study suggested that patients who underwent MIPO were more superior in malunion, and intramedullary nailing (IMN) did not have advantages in radiation time, nonunion or delayed union rate, union time and operation time compared with MIPO
Summary
Distal tibia fractures occurred in patients commonly as a result of a force directed from the foot towards the leg in high energy traumatic events, such as falling down, traffic accident, motorcycle accident, or sport injury[1]. Considering the need for anatomical reduction and rigid internal fixation sometimes, it might be necessary to widely expose the surrounding tissues of the fracture, which could cause delayed union or nonunion owing to over-destruction of soft tissue and blood supply around the fracture[2]. The common surgical procedures included intramedullary nailing, minimally invasive plate osteosynthesis (MIPO), open reduction and internal fixation (ORIF), and external fixation. Intramedullary nails were widely used because of their successful outcomes and minimal damage to bone and soft tissue, especially in open fractures[3]. Delayed bone healing, reoperation, and a high incidence of primary and secondary malalignment have been reported, especially in distal and proximal tibial fractures, which may associated with the large cavity[6]
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