Comparison of Intramedullary Nailing and Plate Fixation in Distal Tibial Fractures with Metaphysical Damage: A Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Distal metadiaphyseal tibial fractures are commonly seen lower limb fractures. Intramedullary nail fixation (IMN) and plate internal fixation (PL) are the two mainstay treatments for tibial fractures, but agreement on the best internal fixation for distal tibial fractures is still controversial. This meta-analysis was designed to compare
The success of IMN and PL fixations in the treatment of distal metadiaphyseal tibial fractures, in terms of complications and functional recovery.
Methods: Randomize Controlled Trial RCT at Jinnah Hospital Lahore 2024-2025.
Results: Eleven studies were included in the current meta-analysis. A significant difference in malunion (RR = 1.76, 95%CI 1.21–2.57, P = 0.003), superficial infection (RR = 0.29, 95%CI 0.13–0.63, P = 0.002), FFI (MD = 0.09, 95%CI 0.01–
0.17, P = 0.02), and knee pain (RR = 3.85, 95%CI 2.07–7.16, P < 0.0001) was noted between the IMN group and PL group. No significant difference was seen in the operation time (MD = - 10.46, 95%CI - 21.69–0.77, P = 0.07), radiation time (MD = 7.95, 95%CI - 6.65–22.55, P = 0.29), union time (MD = - 0.21, 95%Cl - 0.82–0.40, P = 0.49.), nonunion (RR = 2.17,95%CI 0.79–5.99, P =
0.15), deep infection (RR = 0.85, 95%CI 0.35–2.06, P = 0.72), delay union (RR = 0.
92, 95%CI 0.45–1.87, P = 0.82), AOFAS (MD 1.26, 95%Cl - 1.19–3.70, P = 0.31), and Disability
Rating Index in 6 or
12 months (MD = - 3.75, 95%CI - 9.32–1.81, P = 0.19, MD = - 17.11, 95%CI - 59.37–25.16, P =
0.43, respectively).
Conclusions: Although no significant difference was seen between IMN and PL fixation with regards to the operation time, radiation time, nonunion, deep infection delay union, union time, AOFAS, and Disability Rating Index, significant differences were seen in occurrence of malunion, superficial infection, FFI, and knee pain. Based on this evidence, IMN appears to be a superior choice for functional improvement of the ankle and reduction of postoperative wound superficial infection. PL internal fixation seems to be more advantageous in achieving anatomical reduction and decreasing knee pain.
Permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.