Treatment of Extra-Articular Distal Tibial Fractures: Minimally Invasive Percutaneous Plate Osteosynthesis Versus Intramedullary Nailing

Ali, Nadeem; Bhat, Abid; Bangroo, Firdous Ahmad; Muzzafar, Khalid; Bhat, Suhail Ahmad; Dhanda, Manjeet Singh; Maqsood, Mehreen

doi:10.5812/traumamon.19593

Cited by 8 publications

(15 citation statements)

References 18 publications

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“…1 ). After screening, 10 RCTs were considered relevant ( 13 – 22 ). One study reported outcomes at 6 months and at 1 year in two different publications ( 22 , 23 ).…”

Section: Resultsmentioning

confidence: 99%

“…In the IMN group, the patella tendon splitting incision was used in four studies ( 15 , 16 , 18 , 19 ); in one study, the patella tendon was retracted laterally ( 20 ), and five studies did not specify the used incision ( 13 , 14 , 17 , 21 , 22 ). A postoperative short-leg splint or cast was used for 3 weeks in one study ( 13 ); five studies allowed active range of motion in ankle and knee joints during the first postoperative week ( 14 , 16 , 18 , 20 , 22 ), while the rest did not specify the immobilization protocol ( 15 , 17 , 19 , 21 ). In all studies, the allowance of weight bearing was assessed individually, usually only after a bony callus was seen in X-ray images.…”

Section: Resultsmentioning

confidence: 99%

“…The patient follow-up varied from 9 to 71 months. The overall systematic risk of bias was considered low in 2 ( 14 , 22 ) and high in 8 ( 13 , 15 – 21 ) of the included RCTs ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

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Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis

et al. 2020

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Background and Aims: To evaluate evidence on the superiority of plate fixation over intramedullary nail fixation in the treatment of distal tibial fractures regarding functional outcomes and complication rates. Material and Methods: Cochrane Controlled Trials Register, Medline, Embase, CINAHL, Scopus, and Web of Science databases were searched in December 2019. The risk of systematic bias was assessed according to the Cochrane Collaboration’s domain-based evaluation framework. Results: The search resulted in 514 records, the final sample included 10 randomized controlled trials (782 patients). There were statistically significant differences in operating time (−11.2, 95% confidence interval: −16.3 to −6.1 min), time to partial weight bearing (−0.96, 95% confidence interval: −1.8 to −0.1 weeks), time to full weight bearing (−2.2, 95% confidence interval: −4.32 to −0.01 weeks), the rates of deep infections (risk ratio = 0.37, 95% confidence interval: 0.19 to 0.69), and the rates of soft-tissue complications (risk ratio = 0.52, 95% confidence interval: 0.33 to 0.82) favoring intramedullary nail. Intraoperative blood loss (127.2, 95% confidence interval: 34.7 to 219.7 mL) and postoperative knee pain and stiffness (relative risk = 5.6, 95% confidence interval: 1.4–22.6) showed significant differences favoring plate fixation. When combining all complication rates, the difference was risk ratio = 0.77 (95% confidence interval: 0.63 to 0.95) favoring intramedullary nail. No significant differences in radiation time, length of incision, length of hospital stay, time to return to work, time to union, the rates of healing complications or secondary procedures, ankle pain or stiffness, or functional scores were found. Conclusion: This meta-analysis suggests that intramedullary nail might be slightly superior in reducing postoperative complications and result in slightly faster healing when compared to plate fixation.

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“…1 ). After screening, 10 RCTs were considered relevant ( 13 – 22 ). One study reported outcomes at 6 months and at 1 year in two different publications ( 22 , 23 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis

et al. 2020

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“…The intramedullary nails provide three point fixation, elastic impringement and provides stability by interlocking bolts at both the proximal and distal to the fracture site. Intramedullary nails for distal tibia fracture reduces surgical injuries to the bone and the soft tissues [7] . It reduces the time of union as the nails cannot be rigid and the movement at the fracture site along with axial micro motion in dynamically locked nails promotes external bridging callus.…”

Section: Introductionmentioning

confidence: 99%

“…There are a number of complications associated with the fracture of distal tibia such as non-union or delayed union of the fractured bone, malunion, shortening, infection, compartment syndrome, i.e. fracture with soft tissue injury, necrosis of the skin, joint stiffness, traumatic arthritis, reflex sympathetic dystrophy, refracture and fat embolism (7).…”

Section: Introductionmentioning

confidence: 99%

A comparative study of locking plate by MIPO versus closed interlocking intramedullary nail in extra-articular distal tibia fractures

Gonsalves¹

2018

Int. J. Orthop. Sci.

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Background: Distal tibia fractures have the second highest incidence of all tibia fractures after the middle third fracture of the tibia. Management of the distal tibia fractures is the most challenging due to its superficial nature and propinquity to the ankle joint. There are various management methods of distal tibia fractures. Distal tibia fractures can be managed using closed reduction and casting or surgical interventions such as closed reduction and intramedullary nailing or open reduction and internal fixation with plating or closed reduction and percutaneous plating or external fixators. Methods: A comparative study of locking plate by MIPO versus closed interlocking intramedullary nailing in extra-articular distal tibia fractures was undertaken among 30 patients with closed extraarticular distal tibia fractures, in the department of orthopedics, Ruby Hall Clinic, Pune from March 2014 to March 2015. The results were assessed using Johner and Wruh's criteria. Results: 15 patients were treated with closed interlocking intramedullary nail and 15 patients with MIPO technique. The patients were operated. No difference was observed in terms of duration of surgery, time for fracture union and malunion. Difference was observed in the terms of total weight bearing after surgery, infection and other complications. Conclusion:It is observed that interlocking nailing is better in terms of early total weight bearing, fast union, and decreased risks of complications. Thus, it is a better choice for patient undergoing the treatment for extra-articular distal tibia fractures.

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RETRACTED: Effects of intramedullary nailing and internal fixation plates on postoperative wound infection and pain in patients with distal tibia fractures: A meta‐analysis

Kou,

2023

International Wound Journal

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A meta‐analysis was performed to assess the effects of intramedullary nailing (IMN) and internal fixation plates (IFP) on postoperative wound infection and pain in patients with distal tibia fractures, to provide evidence for the selection of surgical options for this group of patients. Computerised searches were performed on PubMed, Cochrane Library, EMBASE, MEDLINE, CNKI and Wanfang databases from the inception of each library to August 2023. All published randomised controlled trials (RCTs) comparing IMN with IFP for the treatment of patients with distal tibial fractures were selected. Literature screening, data extraction and literature evaluation were independently completed by two researchers. Data analysis was performed using the Review Manager 5.4 software. Overall, 25 RCTs with a total of 2011 patients were finally included, comprised by 1009 patients in the IMN group and 1002 patients in the IFP group. The rate of wound infection was significantly lower in the IMN group than that in the IFP group (5.05% vs. 9.58%, odds ratio [OR]: 0.52, 95% confidence intervals [CIs]: 0.37–0.73, p < 0.001). Meanwhile, the IMN group had a significantly higher rate of joint pain than that of the IFP group (14.57% vs. 2.90%, OR: 4.93, 95% CIs: 3.02–8.03, p < 0.00001), whereas the difference between the two surgical procedures in terms of operative time was not statistically significant (standardised mean differences: 0.08 95% CIs: −0.58–0.74, p = 0.82). Current clinical evidence suggests that both IMN and IFP are excellent treatments for distal tibial fractures. Although IMN is better in reducing postoperative wound infection, the risk of postoperative pain is higher. Thus, an appropriate surgical procedure should be selected in clinical practice in accordance with the actual situation of the patient, and IFP is used to reduce the incidence of postoperative joint pain when the anterior tibial soft tissue of the distal tibial fracture is in good condition, and vice versa. IMN is used to reduce the risk of infection.

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Treatment of Extra-Articular Distal Tibial Fractures: Minimally Invasive Percutaneous Plate Osteosynthesis Versus Intramedullary Nailing

Cited by 8 publications

References 18 publications

Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis

Comparison Between Nailing and Plating in the Treatment of Distal Tibial Fractures: A Meta-Analysis

A comparative study of locking plate by MIPO versus closed interlocking intramedullary nail in extra-articular distal tibia fractures

RETRACTED: Effects of intramedullary nailing and internal fixation plates on postoperative wound infection and pain in patients with distal tibia fractures: A meta‐analysis

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