Treatment of distal tibia fractures with intramedullary nail or plate: A meta-analysis

Objectives: To evaluate the outcome of intramedullary nail and plate fixation for the treatment of extra-articular fractures of the distal tibia and to determine whether there are sufficient objective data in the literature to compare the two methods. Methodology: A comprehensive search of all relevant articles from Jan 1975 to Dec 2011 was conducted. Two reviewers evaluated each study to determine its suitability for inclusion and collected the data of interest. Meta-analytic pooling of group results across studies was performed for the two treatment methods. Results: The systematic review identified 22 primary studies with 880 fractures including 15 groups of intramedullary nail and 15 groups of plate. For extra-articular distal tibia fractures, shorter healing time can be achieved by using the intramedullary nail, but the malformation rate was significantly higher than in the plate group. The average operating time in the intramedullary nail group was longer than in the plate group, but the difference was not statistically significant. No statistically significant difference was found when comparing the rates of infection, rotation, shortening, delayed union and nonunion. The reoperation rate was higher in the intramedullary nail group compared with the plate group, but the difference was also not statistically significant. Conclusions: The functional and efficacy outcomes appear to be similar between the two treatment groups. Thus the patient’s general condition and the surgeon’s preference dictate the choice of surgical technique.