Intramedullary Nail Versus Plate For Distal Tibia Fractures In Adults:A Systematic Review

Objective:To systematically review the clinical efficacy and the complications of intramedullary nail and plate in the treatment of distal tibia fractures in adults,and to provide reference for clinical practice and research.Methods:A comprehensive search was conducted for the studies from January 2005 to October 2016 on the intramedullary nail and plate in the treatment of distal tibia fractures in The Cochrane Library,Springer,Pubmed,Medline Embase,CNKI,Wanfang Data and manually as well.All randomized controlled trials(RCTs)were met the eligible criteria.The quality evaluation criteria was used to evaluate the quality of the included literature.RevMan5.3 provided by Cochrane was used to analyze the data.Results:A total of 7 randomized controlled trials(n = 514)were included involving 514 participants(IMN:267;Plate:247).There were no significant differences between IMN and plate treatments in deep infection,the rates of delyed union,the rates of malunion,the rates of nonunion,the rates of removal of metal work.However,IMN achieved a significant lower superficial infection incidence [RR=2.44,95% CI(1.11,5.23),P<0.05];Conclusion:For adult distal tibial fractures,the superficial infection rate of the plate group is significantly higher than that of the intramedullary nail group.Therefore,special attention should be paid to the aseptic operation when using the plate treatment.Minimally invasive and soft tissue protection measures should be taken as far as possible.