title: Intramedullary nail versus plate treatments for distal tibial fractures: a meta-analysis.
abstract: BACKGROUND
  Controversy remained on whether the optimal treatment for distal tibial fractures is intramedullary nail (IMN) or plate.
  
  
  METHODS
  Databases including PubMed, Embase, Cochrane library, Wanfang and CNKI were retrieved up to May 31, 2014 for eligible studies. Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to evaluate literature qualities. Q and I(2) test were applied to estimate heterogeneities. Moreover, subgroup analyses were performed and publication bias was detected. Mean difference (MD) and relative risk (RR), with their corresponding 95% confidence interval (CI) were used to calculate the pooled results.
  
  
  RESULTS
  Sixteen studies were included involving 1140 participants (IMN: 599; plate: 541). There were no significant differences between IMN and plate treatments in operation time (OT), hospital time (HT), union time (UT), and incidence of deep infection (DI) and union complications (UC). However, IMN achieved a significant lower superficial infection (SI) incidence (RR, 0.41; 95% CI, 0.23 to 0.71; P = 0.001) and a significant higher malunion incidence (RR, 2.27; 95% CI, 1.56 to 3.31; P < 0.001). In subgroup analyses, IMN had significant shorter OT than plate in randomized controlled trials (RCTs) (MD, -19.04; 95% CI, -24.86 to -13.21; P < 0.0001), but comparable incidence of SI to plate in non-Asia countries. No obvious publication bias was indicated in UT and malunion.
  
  
  CONCLUSIONS
  For distal tibial fractures treatment, IMN might be advantageous over plate with lower SI incidence, and comparable UT, OT and HT. Meanwhile, IMN was related to higher risk of malunion. However, more RCTs are warranted.
authors.affiliation: Department of Traumatic Orthopaedic, The First People's Hospital of Lianyugang, Lianyugang 222000, Jiangsu Province, China.
authors.forename: Jiwen
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Traumatic Orthopaedic, The First People's Hospital of Lianyugang, Lianyugang 222000, Jiangsu Province, China. Electronic address: leiminglidr@163.com.
authors.forename: Leiming
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Traumatic Orthopaedic, The First People's Hospital of Lianyugang, Lianyugang 222000, Jiangsu Province, China.
authors.forename: Tong
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Traumatic Orthopaedic, The First People's Hospital of Lianyugang, Lianyugang 222000, Jiangsu Province, China.
authors.forename: Luxin
authors.initials: L
authors.lastname: Sheng
authors.affiliation: Department of Traumatic Orthopaedic, The First People's Hospital of Lianyugang, Lianyugang 222000, Jiangsu Province, China.
authors.forename: Yongfeng
authors.initials: Y
authors.lastname: Huo
authors.affiliation: Department of Traumatic Orthopaedic, The First People's Hospital of Lianyugang, Lianyugang 222000, Jiangsu Province, China.
authors.forename: Zhaoyang
authors.initials: Z
authors.lastname: Yin
authors.affiliation: Department of Traumatic Orthopaedic, The First People's Hospital of Lianyugang, Lianyugang 222000, Jiangsu Province, China.
authors.forename: Guangxue
authors.initials: G
authors.lastname: Gu
authors.affiliation: Department of Traumatic Orthopaedic, The First People's Hospital of Lianyugang, Lianyugang 222000, Jiangsu Province, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: He
mesh_terms: D001860:Bone Plates; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008297:Male; D017594:Publication Bias; D013978:Tibial Fractures / Q000601:surgery*
keywords: Distal tibial fractures; Intramedullary nail; Malunion; Meta-analysis; Plate; Union complication