Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis

Journal of Orthopaedic Surgery and Research

Peifu Tang¹  Yanpeng Zhao¹  Hailong Du¹  Shuo Chen²  Licheng Zhang¹  Lihai Zhang¹  Guoqi Wang¹  Zhi Mao³ 

[1] Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, People’s Republic of China;Department of Medical Information, Chinese PLA General Hospital, Beijing 100853, People’s Republic of China;Department of Microsurgery, PLA 205 Hospital, Guta Area, JinZhou 121001, Liaoning, People’s Republic of China

关键词: Meta-analysis;    Plating;    Intramedullary nailing;    Distal tibia;    Tibia fracture;   

Others  :  1218702
DOI  :  10.1186/s13018-015-0217-5

 received in 2015-01-10, accepted in 2015-05-08,  发布年份 2015

【 摘 要 】

Background

The choice between intramedullary (IM) nailing or plating of distal tibia fractures without articular involvement remains controversial. A meta-analysis of randomized controlled trials (RCTs) and observational studies was performed to compare IM nailing with plating for distal tibia fractures without articular involvement and to determine the dominant strategy.

Materials and methods

The PubMed, Embase, Cochrane Library databases, Chinese Wan-Fang Database, and China National Knowledge Infrastructure were searched.

Results

Twenty-eight studies, which included 1863 fractures, met the eligible criteria. The meta-analysis did not identify a statistically significant difference between the two treatments in terms of the rate of deep infection, delayed union, removal of instrumentation, or secondary procedures either in the RCT or retrospective subgroups. IM nailing was associated with significantly more malunion events and a higher incidence of knee pain in the retrospective subgroup and across all the studies, but not significantly in the RCT subgroup, and a lower rate of delayed wound healing and superficial infection both in the RCT and retrospective subgroups relative to plating. A meta-analysis of the functional scores or questionnaires was not possible because of the considerable variation among the included studies, and no significant differences were observed.

Conclusions

Evidence suggests that both IM nailing and plating are appropriate treatments as IM nailing shows lower rate of delayed wound healing and superficial infection and plating may avoid malunion and knee pain. These findings should be interpreted with caution, however, because of the heterogeneity of the study designs. Large, rigorous RCTs are required.

【 授权许可】

   
2015 Mao et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Fig. 6.

【 参考文献 】

• [1]Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures. Injury. 2011; 42:975-84.
• [2]Mauffrey C, McGuinness K, Parsons N, Achten J, Costa ML. A randomised pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia. J Bone Joint Surg (Br). 2012; 94:704-8.
• [3]Casstevens C, Le T, Archdeacon MT, Wyrick JD. Management of extra-articular fractures of the distal tibia: intramedullary nailing versus plate fixation. J Am Acad Orthop Surg. 2012; 20(11):675-83.
• [4]Richard RD, Kubiak E, Horwitz DS. Techniques for the surgical treatment of distal tibia fractures. Orthop Clin North Am. 2014; 45:295-312.
• [5]Bedi A, Le TT, Karunakar MA. Surgical treatment of nonarticular distal tibia fractures. J Am Acad Orthop Surg. 2006; 14:406-16.
• [6]Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Joint Surg Am. 2005; 87:1213-21.
• [7]Hahn D, Bradbury N, Hartley R, Radford PJ. Intramedullary nail breakage in distal fractures of the tibia. Injury. 1996; 27:323-7.
• [8]Robinson CM, McLauchlan GJ, McLean IP, Court-Brown CM. Distal metaphyseal fractures of the tibia with minimal involvement of the ankle. Classification and treatment by locked intramedullary nailing. J Bone Joint Surg (Br). 1995; 77:781-7.
• [9]Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibia shaft fractures (4 to 11 cm proximal to the plafond): plating versus intramedullary nailing. J Orthop Trauma. 2008; 22:307-11.
• [10]Im GI, Tae SK. Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma. 2005; 59(5):1219-23.
• [11]Yang SW, Tzeng HM, Chou YJ, Teng HP, Liu HH, Wong CY. Treatment of distal tibial metaphyseal fractures: plating versus shortened intramedullary nailing. Injury. 2006; 37:531-5.
• [12]Seyhan M, Unay K, Sener N. Intramedullary nailing versus percutaneous locked plating of distal extra-articular tibial fractures: a retrospective study. Eur J Orthop Surg Traumatol. 2012; 23:595-601.
• [13]Janssen KW, Biert J, van Kampen A. Treatment of distal tibial fractures: plate versus nail: a retrospective outcome analysis of matched pairs of patients. Int Orthop. 2007; 31:709-14.
• [14]Li Y, Liu L, Tang X, Pei F, Wang G et al.. Comparison of low, multidirectional locked nailing and plating in the treatment of distal tibial metadiaphyseal fractures. Int Orthop. 2012; 36:1457-62.
• [15]Yavuz U, Sokucu S, Demir B, Yildirim T, Ozcan C et al.. Comparison of intramedullary nail and plate fixation in distal tibia diaphyseal fractures close to the mortise. Ulus Travma Acil Cerrahi Derg. 2014; 20:189-93.
• [16]Zhang C, Jiang Y, An ZQ, Wang JW, Shen J. Interlocking intramedullary nailing versus percutaneous plating in osteosynthesis of metaphyseal fractures of distal tibia. Chin J Orthop Trauma. 2007; 9:131-4.
• [17]Chen NHQ. Clinical analysis for two fixation methods in distal tibiofibular fracture. Pract Clin Med. 2008; 3:116-7.
• [18]Huang JJ. A comparative study between interlocking intramedullary nail and percutaneous plate fixation for distal tibial fractures. Guangxi Med J. 2008; 30:1355-7.
• [19]Ni XY, Liu F, Shao YW, Zhang H, Gao WR. Comparison of intramedullary and extramedullary fixation for distal tibial fracture. Acta Universitatis Medicinalis Nanjing(Natural Science). 2010;30:538-542.
• [20]Wu SH, Wang SJ, Wang YW, Zhou LJ. Two surgical methods for distal tibial fractures. Jilin Med J. 2011; 32:6404-5.
• [21]Huang YQ, Liu XM, Chen WM, Huang HW. Comparison of intramedullary nails plus blocking screws and percutaneous locking compression plates for distal tibial metaphyseal fractures. Pract Clin Med. 2012; 13:33-6.
• [22]Jin B, Zhang W. Locking compression plate fixation for distal tibial fracture. Chi Manipulation & Rehabil Med. 2012; 03:202.
• [23]Ren ZQ, Jiao WX, Wang ZH. Locking intramedullary nail and plate fixation for distal tibial fractures. Chin J Clin Ration Drug Use. 2012; 5:90-1.
• [24]Tan H. The clinical research of intramedullary nail fixation for distal tibial fractures. Hebei Med. 2012; 18:1394-7.
• [25]Yang ZY, Liu F, Liu GQ, Zang JC, Wu Y et al.. Interlocking intramedullary nailing versus locking plating for distal tibia fractures. Orthopedic J China. 2012; 20:566-7.
• [26]Ke DF, Zeng QT. Study on the clinical effects of interlocking intramedullary nailing in internal fixation of distal tibia fractures. China Foreign Med Treat. 2013; 28:25-6.
• [27]Wang SK, Shi ZX, Liu XM, Liu CGA. Comparative study of intramedullary nail and locking plate fixation of the distal tibial metaphyseal fractures. Chin J Bone Joint Inj. 2013; 28:977-8.
• [28]Yao Q, Ni J, Peng LB, Yu DX, Yuan XM. Locked plating with minimally invasive percutaneous plate osteosynthesis versus intramedullary nailing of distal extra-articular tibial fracture: a retrospective study. Zhonghua Yi Xue Za Zhi. 2013; 93:3748-51.
• [29]Zhu WG. Clinical effects of expert tibial nail in treating distal tibial fracture. J Tissue Eng Reconstr Surg. 2013; 9:276-8.
• [30]Dong AJA. Comparative study on ultra distal interlocking intramedullary nail and medial distal tibial locking compression plate in treatment of distal tibial fracture. Chin Med Innov. 2014; 11:146-8.
• [31]Guo YQ, Li GW, Luo JH, Chen T, Huang CX et al.. Percutaneous plating and intramedullary nailing for distal tibia fractures. Guangdong Med J. 2014; 35:2201-4.
• [32]Feng YZ, Hong JJ, Peng L, Shui XL, Tang J et al.. Comparison of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures. Zhonghua Wai Ke Za Zhi. 2011; 49:113-8.
• [33]Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg (Br). 2010; 92:984-8.
• [34]Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma. 2011; 25:736-41.
• [35]Vallier HA, Cureton BA, Patterson BM. Factors influencing functional outcomes after distal tibia shaft fractures. J Orthop Trauma. 2012; 26:178-83.
• [36]Xue XH, Yan SG, Cai XZ, Shi MM, Lin T. Intramedullary nailing versus plating for extra-articular distal tibial metaphyseal fracture: a systematic review and meta-analysis. Injury. 2014; 45:667-76.
• [37]Kwok CS, Crossman PT, Loizou CL. Plate versus nail for distal tibial fractures: a systematic review and meta-analysis. J Orthop Trauma. 2014; 28:542-8.
• [38]Li Y, Jiang X, Guo Q, Zhu L, Ye T et al.. Treatment of distal tibial shaft fractures by three different surgical methods: a randomized, prospective study. Int Orthop. 2014; 38:1261-7.
• [39]Higgins JP, Green S Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [Updated March 2011]. The Cochrane Collaboration. http://www. cochrane.org/training/cochrane-handbook webcite
• [40]Zeng X, Zhang Y, Kwong JS, Zhang C, Li S et al.. The methodological quality assessment tools for pre-clinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evidence-based Med. 2015; 8:2-10.
• [41]Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003; 73:712-6.
• [42]Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003; 327:557-60.
• [43]DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986; 7:177-88.
• [44]Salen BA, Spangfort EV, Nygren AL, Nordemar R. The Disability Rating Index: an instrument for the assessment of disability in clinical settings. J Clin Epidemiol. 1994; 47:1423-35.
• [45]Lefaivre KA, Slobogean GP. Understanding systematic reviews and meta-analyses in orthopaedics. J Am Acad Orthop Surg. 2013; 21:245-55.
• [46]Strauss EJ, Alfonso D, Kummer FJ, Egol KA, Tejwani NC. The effect of concurrent fibular fracture on the fixation of distal tibia fractures: a laboratory comparison of intramedullary nails with locked plates. J Orthop Trauma. 2007; 21:172-7.
• [47]Lau TW, Leung F, Chan CF, Chow SP. Wound complication of minimally invasive plate osteosynthesis in distal tibia fractures. Int Orthop. 2008; 32:697-703.
• [48]Weil YA, Gardner MJ, Boraiah S, Helfet DL, Lorich DG. Anterior knee pain following the lateral parapatellar approach for tibial nailing. Arch Orthop Trauma Surg. 2009; 129:773-7.
• [49]Vaisto O, Toivanen J, Kannus P, Jarvinen M. Anterior knee pain after intramedullary nailing of fractures of the tibial shaft: an eight-year follow-up of a prospective, randomized study comparing two different nail-insertion techniques. J Trauma. 2008; 64:1511-6.
• [50]Ahmad MA, Sivaraman A, Zia A, Rai A, Patel AD. Percutaneous locking plates for fractures of the distal tibia: our experience and a review of the literature. J Trauma Acute Care Surg. 2012; 72:E81-7.
• [51]Rouhani A, Elmi A, Akbari Aghdam H, Panahi F, Dokht Ghafari Y. The role of fibular fixation in the treatment of tibia diaphysis distal third fractures. Orthop Traumatol Surg Res. 2012; 98:868-72.