title: Intramedullary nailing versus plating for distal tibia fractures without articular involvement: a meta-analysis.
abstract: BACKGROUND
  The choice between intramedullary (IM) nailing or plating of distal tibia fractures without articular involvement remains controversial. A meta-analysis of randomized controlled trials (RCTs) and observational studies was performed to compare IM nailing with plating for distal tibia fractures without articular involvement and to determine the dominant strategy.
  
  
  METHODS
  The PubMed, Embase, Cochrane Library databases, Chinese Wan-Fang Database, and China National Knowledge Infrastructure were searched.
  
  
  RESULTS
  Twenty-eight studies, which included 1863 fractures, met the eligible criteria. The meta-analysis did not identify a statistically significant difference between the two treatments in terms of the rate of deep infection, delayed union, removal of instrumentation, or secondary procedures either in the RCT or retrospective subgroups. IM nailing was associated with significantly more malunion events and a higher incidence of knee pain in the retrospective subgroup and across all the studies, but not significantly in the RCT subgroup, and a lower rate of delayed wound healing and superficial infection both in the RCT and retrospective subgroups relative to plating. A meta-analysis of the functional scores or questionnaires was not possible because of the considerable variation among the included studies, and no significant differences were observed.
  
  
  CONCLUSIONS
  Evidence suggests that both IM nailing and plating are appropriate treatments as IM nailing shows lower rate of delayed wound healing and superficial infection and plating may avoid malunion and knee pain. These findings should be interpreted with caution, however, because of the heterogeneity of the study designs. Large, rigorous RCTs are required.
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. maozhiys@sina.com.|Department of Microsurgery, PLA 205 Hospital, Guta Area, JinZhou, Liaoning, 121001, People's Republic of China. maozhiys@sina.com.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. guoqi71@126.com.
authors.forename: Guoqi
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. zhanglihai301@gmail.com.
authors.forename: Lihai
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. zhanglcheng218@126.com.
authors.forename: Licheng
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Medical Information, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China. 157972625@qq.com.
authors.forename: Shuo
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. 48620965@qq.com.
authors.forename: Hailong
authors.initials: H
authors.lastname: Du
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. 476499208@qq.com.
authors.forename: Yanpeng
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Orthopedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, People's Republic of China. pftang301@163.com.
authors.forename: Peifu
authors.initials: P
authors.lastname: Tang
mesh_terms: D001858:Bone Nails; D001860:Bone Plates; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome