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

Mao Z, Wang G, Zhang L, Zhang L, Chen S, Du H, Zhao Y, Tang P - J Orthop Surg Res (2015)

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. maozhiys@sina.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Study selection and inclusion process
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Fig1: Study selection and inclusion process

Mentions: The initial search retrieved 337 studies. After examining the titles, abstracts, and full text of the short-listed papers, 29 studies [2, 9–35, 38] were identified as suitable. Two studies used the same population database [34, 35]. We selected outcomes mainly from the later study because it was more informative [35]. Thus, 28 studies were identified at last. The literature selection process is illustrated in Fig. 1. The characteristics and demographic data of each included study are summarized in Table 1.Fig. 1


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

Mao Z, Wang G, Zhang L, Zhang L, Chen S, Du H, Zhao Y, Tang P - J Orthop Surg Res (2015)

Study selection and inclusion process
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4481115&req=5

Fig1: Study selection and inclusion process
Mentions: The initial search retrieved 337 studies. After examining the titles, abstracts, and full text of the short-listed papers, 29 studies [2, 9–35, 38] were identified as suitable. Two studies used the same population database [34, 35]. We selected outcomes mainly from the later study because it was more informative [35]. Thus, 28 studies were identified at last. The literature selection process is illustrated in Fig. 1. The characteristics and demographic data of each included study are summarized in Table 1.Fig. 1

Bottom Line: 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. maozhiys@sina.com.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus