Nailing Versus Plating in the Management of Proximal Extra-Articular Tibial Fractures: A Systematic Review

Abstract

Background: Problem both intramedullary nailing (IMN) and plating have pearls and pitfalls in treating proximal tibial extra-articular fractures. The current study sought to provide clinical evidence for comparison of the two methods in treating such injury. Methods:A systematic search for articles published from January, 1990 to September, 2016, using PubMed, Embase and the Cochrane library was conducted. Clinical researches comparing the outcomes of nailing and plating for proximal extra-articular tibial fractures, on human subjects over 18 years old were included. No limit of language and publication status was applied. The quality of the included randomized controlled studies was analyzed with Cochrane Collaboration Risk of Bias Tool. And the non-randomized studies were assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies (RoBANS). Results:Out of 299 preliminary search results, one randomized controlled trial and one retrospective cohort study were included in the current systematic review of 100 cases (44 in the RCT and 56 in the retrospective study, 41 IMN cases and 59 plate cases). Interpretation:The meta-analysis of the current study found similar union rate, mal-union rate and infection rate for IMN and plate. IMN was more patient satisfactory, but at the same time, more technically requiring. However, the final conclusion that IMN and plate had the same outcome in treating proximal tibial extra-articular fractures should still be made with caution, because of the relatively small sample size of this systematic review.

Comparison between plating by MIPPO and IMLN in proximal tibia extra-articular fractures: Our experience at a tertiary care hospital

“…Bhandari et al [13] studied both plating and IMILN and said that there was low evidence of less infection with IMILN but the study did not include MIPPO. Xi Liu and Shiqiang cen et al [2017] [15] In Weiner LS et al [10] series they had 34% excellent, 48% good, 12% fair and 6% poor results. James J. Hutson [11] series 85% were excellent or good results.…”