BackgroundWhether the optimal treatment for tibial shaft fractures is suprapatellar intramedullary nailing or infrapatellar approach is controversial.Materials and methodsPubMed, Embase, Cochrane, Web of science and CNKI, Wan fang Chinese databases were retrieved from their establishment to April 26, 2017. Seven studies (three randomized and four clinical controlled trials) were included in the final analysis. This meta-analysis included 683 patients with tibial shaft fracture (suprapatellar: 341; infrapatellar: 342).ResultsThere was significant difference between suprapatellar and infrapatellar approach surgery in the incidence of knee pain (P = 0.003). The malalignment of the sagittal and coronal plane in suprapatellar surgery was more serious than in the infrapatellar approach (sagittal plane: P < 0.00001; coronal plane:P = 0.07). The infrapatellar approach surgery was more time-consuming than suprapatellar surgery (P = 0.01), with no significant difference in knee function score (P = 0.35).ConclusionsSuprapatellar intramedullary nailing reduced the incidence of knee pain and the average malalignment of fractures compared to infrapatellar intramedullary nailing. It also reduced the operation time and fluoroscopy time. The results of the study should be interpreted with caution due to the heterogeneity of the study designs.

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