MIPPO Versus ETN Fixation In The Treatment Of Distal Tibial Fractures: A Meta-analysis

ObjectiveMinimally invasive percutaneous plate osteosynthesis（MIPPO）and expert tibial nail（ETN）fixation are common internal fixation techniques for the treatment of limb metaphyseal fractures,and have achieved good results.Both of them are widely used in the treatment of distal tibial fracture（DTF）.How to choose and which internal fixation method has more advantages are still controversial.In order to explore the best internal fixation treatment of distal tibial fractures,this paper makes a meta-analysis on the curative effect difference between minimally invasive percutaneous plate and interlocking intramedullary nail in the treatment of distal tibial fractures,so as to provide a theoretical basis for optimizing the selection of internal fixation for clinical treatment of distal tibial fractures.MethodsUsing computer to search CNKI,VIP,Wanfang,Sino Med,Pub Med,EBSCOhost,Embase,Springer Link database,search the literature reports on the treatment of distal tibial fractures with minimally invasive percutaneous plate and expert tibial nail from January 1,2010 to December 31,2021.The literature reports were screened according to the inclusion and exclusion criteria,the quality of the included literature was evaluated,and the basic information of the literature was collected,including the first author,publication year,research type,sample size,gender,age,fracture type.The operation time,fracture healing time,the postoperative weight-bearing time,ankle stiffness rate and postoperative complications（healing rate,delayed healing rate,malunion rate,superficial infection rate,deep infection rate and implant removal rate）were used as the research indicators.The meta-analysis was completed by using Review Manager 5.4 software.ResultsA total of 659 literatures were searched.After screening,the remaining 10 literatures were included in meta-analysis,9 randomized controlled trials and 1 non-randomized controlled trial.A total of 667 patients（335 in MIPO group and 332 in ETN group）were included.There were significant differences in operation time（MD =12.79,95% CI 7.54-18.03,P < 0.05）and superficial infection rate（RR = 2.87,95% CI1.54-5.37,P < 0.05）,MIPO group needs longer operation time and higher superficial infection rate than ETN group.In fracture healing time（SMD=0.33,95%CI-0.05-0.72,P>0.05）,postoperative weight-bearing time（SMD=0.73,95%CI-0.10-1.55,P>0.05）,ankle stiffness rate（RR=1.29,95%CI 0.60-2.78,P>0.05）,total healing rate（RR= 1.00,95%CI 0.97-1.03,P>0.05）,delayed union rate（RR=0.92,95%CI 0.47-1.81,P>0.05）,malunion rate（RR=0.83,95%CI 0.52-1.33,P >0.05）,deep infection rate（RR=1.19,95%CI 0.37-3.82,P>0.05）,implant removal rate（RR=1.17,95%CI 0.97-1.41,P>0.05）,there was no statistical difference.ConclusionCompared with minimally invasive percutaneous plate internal fixation,expert intramedullary nail internal fixation has more advantages in shortening the operation time and reducing the rate of superficial infection;However,there was no difference in fracture healing time,postoperative weight-bearing time,ankle stiffness rate,total healing rate,delayed healing rate,malunion rate,deep infection rate and implant removal rate.Clinicians can make personalized choices according to the wishes of patients and their proficiency in the two internal fixation techniques.