Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis

Wang, Bo; Yang, Zhao; Wang, Qian; Sun, Liang; Ren, Cheng; Zhong, Li; Zhang, Kun; Hao, Dingjun; Ma, Teng; Lu, Yao

doi:10.1186/s13018-019-1479-0

Cited by 37 publications

(33 citation statements)

References 30 publications

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“…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 ]. IMN insertion comprises the traditional infrapatellar (IP) approach and suprapatellar (SP) approach in the semiextended position.…”

Section: Introductionmentioning

confidence: 99%

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

Wang²,

Ren

et al. 2020

J Orthop Surg Res

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Background This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches. Methods A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements. Results A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P > 0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P < 0.05). Conclusions In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

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Section: Introductionmentioning

confidence: 99%

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

Wang²,

Ren

et al. 2020

J Orthop Surg Res

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“…Most studies reported similar AOFAS outcomes in distal tibia fractures treated with IMN and minimally invasive percutaneous plate osteosynthesis. Moreover, our previous study of a meta-analysis on the basis of 13 RCTs with 924 patients indicated that there were no signi cant differences in the AOFAS outcomes between the IMN and minimally invasive percutaneous plate osteosynthesis groups [11]. However, in the current study, we initially used the AOFAS scores to evaluate the functional outcomes of distal tibia fractures using the SP and IP approaches.…”

Section: Discussionmentioning

confidence: 97%

“…In recent years, intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) have become common xation 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]. IMN insertion comprises the traditional infrapatellar (IP) approach and suprapatellar (SP) approach in the semiextended position.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

et al. 2020

Preprint

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Background: This study aimed to analyze and compare the clinical and functional outcomes of distal tibia fractures treated with intramedullary nailing (IMN) using the suprapatellar (SP) and infrapatellar (IP) surgical approaches.Methods: A retrospective analysis was performed in 63 patients with distal fractures that were treated with IMN between August 2014 and August 2018. A total of 27 and 36 patients underwent IMN using the SP and IP techniques, respectively. The surgical time, blood loss, closed reduction rate, rate of adjuvant reduction technique, fracture healing time, and complications were reviewed in this study. Anterior knee pain was assessed using the visual analog scale. The Lysholm Knee Scoring Scale and American Orthopaedic Foot and Ankle Society (AOFAS) scale were used as clinical measurements.Results: A total of 63 patients, with a minimum follow-up of 12 months, were evaluated. The average surgical time, blood loss, rate of adjuvant reduction technique, closed reduction rate, fracture healing time, and Lysholm Knee Scoring Scale score were insignificantly different (P>0.05) between the two groups. However, the SP approach was superior to the IP approach in terms of pain score, AOFAS score, and fracture deformity rate (P<0.05).Conclusions: In the treatment of distal tibia fractures, the SP IMN technique is associated with a significantly higher functional outcome, lower knee pain, and lower rate of fracture deformity than the IP IMN technique.

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“…There are many different nal management options for open distal tibial fractures after early surgical debridement and fracture stabilization. The extent and condition of soft tissue is a prerequisite for any management options [16,17]. Intramedullary nail is considered the optimal management choice in most case scenario [6,13,18,19], it is capable of providing early weight bearing and lower incidence of malalignment with less interference in the soft tissue of fracture site.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

Xu¹,

Ren²,

Zhong³

et al. 2020

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Background To analyze the clinical characteristic and economic of intramedullary nailing versus locking compression plate for the treatment of open distal tibial fractures.Methods A retrospective analysis was conducted by enrolling patients with open distal tibial fractures who were admitted in Lower Limb Surgery Ward of Traumatic Orthopedic Department，Xi’an Honghui Hospital from January 2016 to January 2019. The collected clinical materials and data included gender, age, injury mechanism, smoke and alcohol, comorbidity disease, Gustilo classification, days before operation, final treatment option, surgical duration, intraoperative bleeding loss, length of stay, complications, Johner-Wruhs criteria, total cost within 1 year after surgery (including hospitalization expenses and postoperative rehabilitation or follow-up expenses). All the patients were divided into two groups based on the final treatment options: Group IMN(intramedullary nailing) and Group LCP(locking compression plate). Cost data for each case within 1 year after surgery were analyzed for the cost-effectiveness ratio (CER)and incremental cost-effectiveness ratio (ICER) of IMN versus LCP.Results 49 consecutive cases were enrolled including 28 cases of Group IMN and 21 cases of Group LCP with the excellent and good rate of 82.1% (23 cases) and 85.7% (18 cases) respectively based on Johner-Wruhs criteria. The surgical duration (p=0.017) and intraoperative bleeding loss(p=0.046) were significantly lower in Group IMN than in Group LCP. Total cost within 1 year after surgery(p=0.048) was also less in Group IMN（126435.90±39093.98 CNY）than in Group LCP（147834.60±56821.12 CNY）. No statistically significant difference was discovered on the excellent and good rate of Johner-Wruhs criteria between the two groups(p＞0.05). The average cost for every 1% of excellent and good rate was 1540.02 CNY in Group IMN and 1725.02 CNY in Group LCP. Each 1% increasing of excellent and good rate cost 5944.08 CNY more in Group LCP compared with Group IMN.Conclusions Both the IMN and LCP could provide a satisfactory outcome for open distal tibial fractures. However the IMN was a more cost-effective management than LCP when the economic analysis was included.

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Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for distal tibial fractures: a systematic review and meta-analysis

Cited by 37 publications

References 30 publications

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

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

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

Clinical Characteristics and Economic Analysis of Intramedullary Nailing Versus Plate and Screws for Open Distal Tibial Fractures: a Retrospective Study

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