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

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.

Minimally invasive plate osteosynthesis for short oblique diaphyseal tibia fractures: does fracture site affect the outcomes?

“…Whether in closed or open fractures, IMN appeared to have a lower incidence of wound complications, but MIPO was recommended for the treatment of distal tibia fractures for its advantage in preventing malunion. 2 Our findings also showed that union, nonunion, and malunion rates were acceptable for both distal and midshaft fractures. Although IMN is very common, plate osteosynthesis outcomes with the MIPO technique are also acceptable with respect to healing rate and time.…”

“… 1 These fractures can be treated conservatively, or operatively with intramedullary nailing (IMN), plate osteosynthesis, or external fixation depending on the fracture pattern and soft tissues. 2 , 3 Although improvements have been made in intramedullary nails, locking plates, and minimally invasive plate osteosynthesis (MIPO) techniques, no consensus has been achieved on the optimal surgical technique. 4 , 5 IMN has become popular for the treatment of displaced diaphyseal tibia fractures, especially transverse fractures.…”

Clinical effects of dynamic stabilization with far cortical locking system in the treatment of simple distal-third tibia fractures: A cohort study

“…Distal-third tibia fractures have been noted with a high rate of complication, and its treatment strategy should be carefully planned. As pointed out by some researchers that intramedullary nailing was associated with more malalignment and anterior knee pain [1][2][3][4], plating seemed to be a simple and effective method for this fracture. To protect the blood supply and provide durable stabilization, the bridge technique with a locking plate by minimally invasive plate osteosynthesis was extensively adopted.…”

Comparison of suprapatellar versus infrapatellar approaches of intramedullary nailing for distal tibia fractures

“…However, plate fixation management of these fractures has often resulted in complications such as infections, delayed unions or nonunions, and implant failures [6][7][8]. In recent years, intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) have become common fixation methods for distal tibia fractures [9,10]. Our previous study of a meta-analysis based on 13 randomized controlled trials (RCTs) with 924 patients revealed that IMN for distal tibia fractures is associated with a lower risk of wound complications and a shorter time to union than those for MIPO [11].…”