Comparing intramedullary nailing and plate fixation for treating distal tibail fractures: A meta-analysis of randomized controlled trials.

BACKGROUND: Intramedullary nailing (IMN) and plate have been reported as two effective devices for treating distal extra-articular fractures. However, reports of complications after fractures with use of different tibial fixation techniques in literature are controversial. Thus, we performed a meta-analysis of randomized controlled trials (RCTs) to compare IMN with plate for evaluating the safety and efficacy.

METHODS: The studies were searched from PubMed, Embase, Web of science and the Cochrane Central Register of Controlled Trials by two reviewers up to August 2017. The quality of RCTs was assessed by Cochrane Handbook. Data were extracted from studies and analyzed by Review Manager 5.3. 95% confidence interval (CI) and risk ratio (RR) were calculated for dichotomous data.

RESULTS: Eight RCTs with 482 patients were included in the meta-analysis. We found no statistically significant differences between IMN and plate on union time (SMD = -0.20, 95%CI -0.58 to 0.18, P = 0.3), delayed or nonunion (RR = 1.19, 95%CI 0.66 to 2.14, P = 0.56) and malunion (RR = 1.63, 95%CI 1.01 to 2.65, P = 0.05). IMN group had shorter operative time (P < 0.0001) and radiation time (P < 0.0001), lower incidence of wound complications (P = 0.0003) and higher rate of knee pain (P < 0.0001) than the plate group.

CONCLUSION: The meta-analysis showed that intramedullary nailing reduced the time of surgery and radiation and the risk of wound complications compared with plate fixation. Furthermore, union time and union complications were common following both treatments. Overall, intramedullary nailing is found to be taken priority for distal tibial metaphyseal fractures. More RCTs are required to support current evidence.