Intramedullarv Nailing Versus Plating For Extra-Articular Distal Tibial Metaphvseal Fracture:a Meta-Analysis

Objective With development in techniques of reduction and fixation, there has been a controversy in comparison between intramedullary nailing (IMN) and plating for treatment of distal tibial metaphyseal fracture (DTF). We asked (1) which fixation, IMN or plating, was better in clinical outcomes and complications for the treatment of DTF, and (2) which modifying variables affected the comparative results between two modalities.Methods PubMed, EMBASE, OVID, Scopus, ISI Web of Science, the Cochrane Library, Google Scholar and specific orthopaedic journals were searched from inception to July2013, using the search strategy of "("Fracture Fixation, Intramedullary"[Mesh]) AND ("Tibial Fractures"[Mesh]) AND (plate OR plating)". All prospective and retrospective controlled trials comparing function, pain, bone union and complications between IMN and plating for DTF were identified. Our analysis had no limitation of the language or the publication year. The primary outcome measurement were complication rate, union time, operation time and hospital stays, while the secondary outmen measurement were functional score and pain score.Results Fourteen of6620literatures with842patients were included. IMN was probably preferential to plating for DTF given its higher function score (P=0.01), lower risk of infection (p=0.02), and comparable pain score (P=0.33), total complication rate (P=0.53) and time to union (p=0.86). However, plating had the lower malunion rate than IMN (p<0.0001). All the results were based on the GRADE evidence of moderate quality.Conclusions With a satisfying alignment obtained may IMN be preferential to plating for fixation of DTF with better function and lower risk of infection. However, IMN showed higher malunion rate for fixation of DTF. With the biases in our meta-analysis it will ultimately require a rigorous and adequately powered RCT to prove.