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Abstract：
BACKGROUND: Intramedullary nail (IMN) and plate fixation are the most commonly used surgical modalities for distal tibia fractures. However, the superiority of their efficacy regarding functional outcomes and complications remains controversial. Here, we performed a systematic review and meta-analysis to compare the efficacy of these two modalities.
METHODS: Randomized controlled trials (RCTs) comparing the efficacy of IMN and plate fixation in distal tibia fractures were searched in PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and Cochrane Library up to January 31, 2024. Weighted mean difference (WMD) and odds ratio (OR) with corresponding 95% confidence interval (CI) were estimated using a random-effect model for continuous and categorical outcomes, respectively.
RESULTS: A total of 20 RCTs comprising 1528 patients were included. Compared with plate fixation, IMN significantly shortened surgery time (WMD=-10.73 min, 95%CI: -15.93 to -5.52), union time (WMD=-1.56 weeks, 95%CI: -2.82 to -0.30), and partial (WMD=-1.71 weeks, 95%CI: -1.91 to -0.43) and full (WMD=-2.61 weeks, 95%CI: -3.53 to -1.70) weight-bearing time. IMN was associated with markedly reduced risk of wound infection (OR = 0.44, 95%CI: 0.31-0.63) and secondary procedures (OR = 0.72, 95%CI: 0.55-0.95), but increased the risk of malunion (OR = 1.53, 95%CI: 1.02-2.30) and anterior knee pain (OR = 3.94, 95%CI: 1.68-9.28). The rates of nonunion, delayed union, and functional assessment scores did not significantly differ between the two groups. The percentages of patients obtaining an excellent functional outcome or an excellent and good functional outcome post-operation were comparable.
CONCLUSIONS: Both IMN and plate fixation are effective modalities for the surgical treatment of distal tibia fractures. IMN seems to be preferred since it confers more advantages, but the elevated rates of malunion and knee pain require attention. The decision on fixation modality should be tailored to the specific fracture, considering these pros and cons.
METHODS: Randomized controlled trials (RCTs) comparing the efficacy of IMN and plate fixation in distal tibia fractures were searched in PubMed, Web of Science, EMBASE, ClinicalTrials.gov, and Cochrane Library up to January 31, 2024. Weighted mean difference (WMD) and odds ratio (OR) with corresponding 95% confidence interval (CI) were estimated using a random-effect model for continuous and categorical outcomes, respectively.
RESULTS: A total of 20 RCTs comprising 1528 patients were included. Compared with plate fixation, IMN significantly shortened surgery time (WMD=-10.73 min, 95%CI: -15.93 to -5.52), union time (WMD=-1.56 weeks, 95%CI: -2.82 to -0.30), and partial (WMD=-1.71 weeks, 95%CI: -1.91 to -0.43) and full (WMD=-2.61 weeks, 95%CI: -3.53 to -1.70) weight-bearing time. IMN was associated with markedly reduced risk of wound infection (OR = 0.44, 95%CI: 0.31-0.63) and secondary procedures (OR = 0.72, 95%CI: 0.55-0.95), but increased the risk of malunion (OR = 1.53, 95%CI: 1.02-2.30) and anterior knee pain (OR = 3.94, 95%CI: 1.68-9.28). The rates of nonunion, delayed union, and functional assessment scores did not significantly differ between the two groups. The percentages of patients obtaining an excellent functional outcome or an excellent and good functional outcome post-operation were comparable.
CONCLUSIONS: Both IMN and plate fixation are effective modalities for the surgical treatment of distal tibia fractures. IMN seems to be preferred since it confers more advantages, but the elevated rates of malunion and knee pain require attention. The decision on fixation modality should be tailored to the specific fracture, considering these pros and cons.
摘要：
背景：髓内钉（IMN）和钢板内固定是胫骨远端骨折最常用的手术方式。然而,它们在功能结局和并发症方面的疗效优势仍存在争议.这里,我们进行了系统评价和荟萃分析,以比较这两种模式的疗效.
方法：在PubMed,WebofScience,EMBASE,ClinicalTrials.gov,和Cochrane图书馆至2024年1月31日。加权平均差（WMD）和比值比（OR）以及相应的95％置信区间（CI）使用随机效应模型对连续和分类结果进行估计。分别。
结果：共20个RCTs，包括1528例患者。与钢板固定相比，IMN显著缩短手术时间(WMD=-10.73分钟，95CI：-15.93至-5.52），工会时间(WMD=-1.56周，95CI：-2.82至-0.30），和部分（WMD=-1.71周，95CI：-1.91至-0.43）和完整（WMD=-2.61周，95CI：-3.53至-1.70）负重时间。IMN与伤口感染（OR=0.44，95CI：0.31-0.63）和二次手术（OR=0.72，95CI：0.55-0.95）的风险显着降低相关，但增加了不愈合（OR=1.53，95CI：1.02-2.30）和前膝疼痛（OR=3.94，95CI：1.68-9.28）的风险。骨不连的比率，延迟工会，两组的功能评估评分无显著差异.术后获得出色功能结果或出色和良好功能结果的患者百分比相当。
结论：IMN和钢板内固定都是治疗胫骨远端骨折的有效方法。IMN似乎是首选，因为它赋予了更多的优势，但是畸形愈合和膝盖疼痛的发生率升高需要注意。固定方式的决定应针对特定的骨折，考虑到这些利弊。
方法：在PubMed,WebofScience,EMBASE,ClinicalTrials.gov,和Cochrane图书馆至2024年1月31日。加权平均差（WMD）和比值比（OR）以及相应的95％置信区间（CI）使用随机效应模型对连续和分类结果进行估计。分别。
结果：共20个RCTs，包括1528例患者。与钢板固定相比，IMN显著缩短手术时间(WMD=-10.73分钟，95CI：-15.93至-5.52），工会时间(WMD=-1.56周，95CI：-2.82至-0.30），和部分（WMD=-1.71周，95CI：-1.91至-0.43）和完整（WMD=-2.61周，95CI：-3.53至-1.70）负重时间。IMN与伤口感染（OR=0.44，95CI：0.31-0.63）和二次手术（OR=0.72，95CI：0.55-0.95）的风险显着降低相关，但增加了不愈合（OR=1.53，95CI：1.02-2.30）和前膝疼痛（OR=3.94，95CI：1.68-9.28）的风险。骨不连的比率，延迟工会，两组的功能评估评分无显著差异.术后获得出色功能结果或出色和良好功能结果的患者百分比相当。
结论：IMN和钢板内固定都是治疗胫骨远端骨折的有效方法。IMN似乎是首选，因为它赋予了更多的优势，但是畸形愈合和膝盖疼痛的发生率升高需要注意。固定方式的决定应针对特定的骨折，考虑到这些利弊。
