Systematic reviews related to this topic

loading
6 References (6 articles) loading Revert Studify

Systematic review

Unclassified

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

Authors Mao Z , Wang G , Zhang L , Zhang L , Chen S , Du H , Zhao Y , Tang P
Journal Journal of orthopaedic surgery and research
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis 28 Broad syntheses (1 reference)

This article includes 28 Primary studies 28 Primary studies (28 references)

Loading references information
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. © 2015 Mao et al.

Systematic review

Unclassified

Plate fixation versus intramedullary nailing for displaced extra-articular distal tibia fractures: a system review.

Authors Li B , Yang Y , Jiang LS
Journal European journal of orthopaedic surgery & traumatology : orthopédie traumatologie
Year 2015
Links Pubmed DOI

This article is included in 1 Broad synthesis 8 Broad syntheses (1 reference)

This article includes 8 Primary studies 8 Primary studies (8 references)

Loading references information
PURPOSE: The optimal surgical procedure for displaced extra-articular distal tibia fractures remains debated at present. The objective of this systematic review is to compare the complications and functional outcomes of this type of fracture after plate fixation and intramedullary nailing . METHODS: A computer-aided search of PubMed, Embase and Cochrane was carried out on July, 2012. Two independent reviewers screened and assessed abstracts. Every study published in English about the comparison between plate fixation and intramedullary nailing for displaced extra-articular distal tibia fractures was included. The outcomes were pooled or summarized separately per study according to heterogeneity between studies. Pooled risk ratios (RR) with 95 % confidence intervals (95 % CIs) were calculated by Mantel-Haenszel method using either the fixed effects model or random effects model. RESULTS: Eight studies, with 270 patients in the intramedullary nailing and 217 patients in the plates fixation group, met the inclusion criteria. Functional outcome, days of hospital stay and time for bone union were comparable between intramedullary fixation and plate fixation. Total complication rate was significant higher for intramedullary nailing compared with plate fixation (44.5 vs. 25.8 %, P < 0.001). Similarly, the rate of minor complications was higher for intramedullary nailing than that for plate fixation (35.9 vs. 21.2 % P < 0.001). Major complication rate was 8.52 % for intramedullary nailing and 4.6 % for plate fixation, but the difference had no statistical significance (P = 0.06). Our pooled estimates showed a decreased risk of total complication in plate fixation (RR, 2.38; 95 % CI, 1.13-5.03; P = 0.02). Among these complications, malunion and anterior knee pain were more common in intramedullary nailing than in plate fixation (20.1 vs. 4.5 %, P < 0.001; 4.2 vs. 0.45 %, P = 0.02, respectively). Meanwhile, significantly less wound problems happened in intramedullary nailing than in plate fixation (2.9 vs. 7.5 %, P = 0.03). In addition, locking plate fixation with mini-invasive technique tended to have a lower complication rate than conventional plate fixation, although the difference was not significant (21 vs. 28.4 %, P = 0.26). CONCLUSIONS: The results of this systematic review suggested that plate fixation, especially minimally invasive percutaneous plating osteosynthesis technique would be preferred for extra-articular distal tibia fractures because of its low complication rate. Nevertheless, intramedullary fixation should be taken priority for distal tibia fractures with serious soft tissue injuries.

Systematic review

Unclassified

Surgical interventions for treating distal tibial metaphyseal fractures in adults.

Authors Kuo LT , Chi CC , Chuang CH
Journal Cochrane Database of Systematic Reviews
Year 2015
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis 3 Broad syntheses (1 reference)

This article includes 3 Primary studies 3 Primary studies (3 references)

Loading references information
BACKGROUND: The distal tibial metaphysis is located in the lower (distal) part of the tibia (shin bone). Fractures of this part of the tibia are most commonly due to a high energy injury in young men and to osteoporosis in older women. The optimal methods of surgical intervention for a distal tibial metaphyseal fracture remain uncertain. OBJECTIVES: To assess the effects (benefits and harms) of surgical interventions for distal tibial metaphyseal fractures in adults. We planned to compare surgical versus non-surgical (conservative) treatment, and different methods of surgical intervention. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (9 December 2014), the Cochrane Central Register of Controlled Trials (2014, Issue 12), MEDLINE (1946 to November Week 3 2014), EMBASE (1980 to 2014 Week 48), the Airiti Library (1967 to 2014 Week 8), China Knowledge Resource Integrated Database (1915 to 2014 Week 8), ClinicalTrials.gov (February 2014) and reference lists of included studies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled clinical studies comparing surgical versus non-surgical (conservative) treatment or different surgical interventions for treating distal tibial metaphyseal fractures in adults. Our primary outcomes were patient-reported function and the need for secondary or revision surgery or substantive physiotherapy because of adverse outcomes. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies, assessed the risk of bias in each study and extracted data. We resolved disagreement by discussion and, where necessary, in consultation with a third author. Where appropriate we pooled data using the fixed-effect model. MAIN RESULTS: We included three randomised trials that evaluated intramedullary nailing versus plating in 213 participants, with useable data from 173 participants of whom 112 were male. The mean age of participants in individual studies ranged from 41 to 44 years. There were no trials comparing surgery with non-surgical treatment. The three included trials were at high risk of performance bias, with one trial also being at high risk of selection, detection and attrition bias. Overall, the quality of available evidence was rated as very low for all outcomes, meaning that we are very unsure about the estimates for all outcomes.The results of two large ongoing trials of nailing versus plating are likely to provide sufficient evidence to address this issue in a future update. AUTHORS' CONCLUSIONS: Overall, there is either no or insufficient evidence to draw definitive conclusions on the use of surgery or the best surgical intervention for distal tibial metaphyseal fractures in adults. The available evidence, which is of very low quality, found no clinically important differences in function or pain, and did not confirm a difference in the need for re-operation or risk of complications between nailing and plating.The addition of evidence from two ongoing trials of nailing versus plating should inform this question in future updates. Further randomised trials are warranted on other issues, but should be preceded by research to identify priority questions.

Systematic review

Unclassified

Plate versus nail for distal tibial fractures: a systematic review and meta-analysis.

Authors Kwok CS , Crossman PT , Loizou CL
Journal Journal of orthopaedic trauma
Year 2014
Links Pubmed DOI

This article is included in 1 Broad synthesis 8 Broad syntheses (1 reference)

This article includes 8 Primary studies 8 Primary studies (8 references)

Loading references information
OBJECTIVES: To undertake a systematic review to determine whether there are advantages in using plate or nail fixation for distal meta-diaphyseal tibial fractures with or without articular involvement. DATA SOURCES: Searches using MEDLINE, EMBASE, and Cochrane library. STUDY SELECTION: Studies of parallel group design comparing plate or nail fixation for distal tibial fractures. DATA EXTRACTION: Information on study methods and outcomes. DATA SYNTHESIS: We conducted random effects meta-analysis to evaluate risk of nonunion or delayed union, wound complications and superficial infection, deep infection, and fracture malalignment. RESULTS: We found 8 studies (n = 455, 4 prospective randomized and 4 retrospective cohort) that evaluated plate compared with nail for distal tibial fractures. No significant difference was found between the use of a plate and nail regarding bone union complications [plate, 5.4%; nail, 8.3%; odds ratio (OR), 0.66; 95% confidence interval (CI), 0.28-1.54; I = 0%; P = 0.34], wound complications including superficial infection (plate, 7.9%; nail, 3.2%; OR, 1.83; 95% CI, 0.40-8.46; I = 48%; P = 0.44), and deep infection (plate, 3.5%; nail, 2.8%; OR, 1.32; 95% CI, 0.44-3.91; I = 0%; P = 0.62). We found a significantly reduced risk of fracture malalignment with the use of a plate compared with a nail (plate, 8.7%; nail, 24.9%; OR, 0.33; 95% CI, 0.17-0.64; I = 0%; P = 0.001). CONCLUSIONS: Plate fixation compared with intramedullary nailing is associated with a reduced risk of fracture malalignment with no differences in bone union, wound complications, and superficial infection or deep infection. Current evidence might recommend plate over nail unless there are concerns with the soft tissues. Additional larger scale multicentre randomized controlled trials are required to clarify these issues.

Systematic review

Unclassified

Intramedullary nailing versus plating for extra-articular distal tibial metaphyseal fracture: a systematic review and meta-analysis.

Authors Xue XH , Yan SG , Cai XZ , Shi MM , Lin T
Journal Injury
Year 2014
Links Pubmed DOI

This article is included in 1 Broad synthesis 14 Broad syntheses (1 reference)

This article includes 14 Primary studies 14 Primary studies (14 references)

Loading references information
INTRODUCTION: With development in the techniques of reduction and fixation, there has been a controversy in comparison between intramedullary nailing (IMN) and plating for the treatment of distal tibial metaphyseal fracture (DTF). The study aimed to investigate: (1) which fixation, IMN or plating, was better in the clinical outcomes and in the complications for the treatment of DTF and (2) which modifying variables affected the comparative results between the 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 July 2013, 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 measurements were complication rate, union time, operation time and hospital stays, while the secondary outcome measurements were functional score and pain score. RESULT: Fourteen of 6620 studies with 842 patients were included. IMN was probably preferential to plating for DTF given its higher functional 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 a lower malunion rate than IMN (p<0.0001). All the results were based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence of moderate quality. CONCLUSIONS: With a satisfying alignment obtained, IMN may 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 randomised controlled trial (RCT) to prove. LEVEL OF EVIDENCE: Level III, therapeutic study (systematic review).

Systematic review

Unclassified

Treatment of distal tibia metaphyseal fractures; plating versus intramedullary nailing: a systematic review of recent evidence.

Authors Iqbal HJ , Pidikiti P
Journal Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons
Year 2013
Links Pubmed DOI

This article is included in 1 Broad synthesis 6 Broad syntheses (1 reference)

This article includes 6 Primary studies 6 Primary studies (6 references)

Loading references information
INTRODUCTION: Treatment of distal tibia metaphyseal fractures is challenging. The purpose of this study was to systematically review the recent literature regarding management of extra-articular distal tibia fractures with a view to compare the outcome of intramedullary nailing with plate fixation. METHODS: Advanced literature search was performed using Medline (Ovid), Embase (Ovid) and Cochrane databases. Data were extracted regarding number of participants, fracture fixation devices, percentage of open fractures, malunions, nonunions, wound infections and metal removal etc. RESULTS: After inclusion, exclusion criteria, two RCTs and four retrospective comparative studies were deemed suitable for this review. The overall results showed relatively higher rate of infection in plating group as compared to intramedullary nailing. However malalignment was more common with intramedullary nailing. CONCLUSION: Both techniques can provide adequate treatments in appropriately selected patients. None of the studies had sufficient power to show clinically significant difference. Further studies are required to compare new locking plates with intramedullary nails.