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


METHODS
Searches using MEDLINE, EMBASE, and Cochrane library.


METHODS
Studies of parallel group design comparing plate or nail fixation for distal tibial fractures.


METHODS
Information on study methods and outcomes.


RESULTS
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.
Department of Trauma and Orthopaedics, Ipswich Hospital NHS Trust, Suffolk, United Kingdom.
Chun Shing
CS
Kwok
Paul T
PT
Crossman
Constantinos L
CL
Loizou
D017760:Bone Malalignment / Q000209:etiology; D001858:Bone Nails; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*