Plate vs. nail for extra-articular distal tibia fractures: How should we personalize surgical treatment? A meta-analysis of 1332 patients

Abstract Background Treatment for distal diaphyseal or metaphyseal tibia fractures is challenging and the optimal surgical strategy remains a matter of debate. The purpose this study was to compare plate fixation with nailing in terms operation time, non-union, time-to-union, mal-union, infection, subsequent re-interventions functional outcomes (quality life scores, knee- ankle scores). Methods A search performed PubMed/Embase/CINAHL/CENTRAL all designs comparing intramedullary (IMN). Data were pooled using RevMan presented as odds ratios (OR), risk difference (RD), weighted mean (WMD) standardized (WSMD) 95% confidence interval (95%CI). All analyzes stratified design. Results total 15 studies 1332 patients analyzed, including ten RCTs (n = 873) five observational (n = 459). IMN leads shorter time-to-union (WMD: 0.4 months, 95%CI 0.1 – 0.7), time-to-full-weightbearing 0.6 0.8) duration 15.5 min, 9.3 21.7). Plating lower mal-union (RD: -10%, OR: 0.4, 0.3 0.6), but higher infection 8%, 2.4, 1.5 3.8). No differences detected regard non-union 1%, 0.7, 1.7), 4%, 1.3, 0.8 1.9) (WSMD: -0.4, -0.9 0.1). effect estimates equal except time union mal-union. Conclusion Satisfactory results can be obtained both extra-articular fractures. However, associated rates anterior knee pain while an increased infection. This provides guideline towards personalized approach facilitates shared decision-making treatment definitive should case-based aligned patient-specific needs order minimize complications.