title: Treatment of distal tibia metaphyseal fractures; plating versus intramedullary nailing: a systematic review of recent evidence.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Trauma and Orthopaedic Department, St Helens and Knowsley Teaching Hospitals NHS Trust, Warrington Road, Prescot, Merseyside L35 5DR, UK. hafjavaid@yahoo.com
authors.forename: H J
authors.initials: HJ
authors.lastname: Iqbal
authors.forename: P
authors.initials: P
authors.lastname: Pidikiti
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D017102:Fracture Healing; D006801:Humans; D011859:Radiography; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Distal tibia fracture; Distal tibia metaphyseal fracture; Intramedullary nail; Open reduction and internal fixation; Plate fixation