Interlocking intramedullary nail versus minimally invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults: A meta-analysis

doi:10.3969/j.issn.2095-4344.2013.22.017

Abstract

Abstract:

BACKGROUND: The invasive internal fixation method for the treatment of middle and distal tibial fracture includes interlocking intramedullary naill and minimally invasive percutaneous plate osteosynthesis in clinic. A large number of retrospective studies have confirmed the effectiveness of these two strategies, but there is still no conclusion in which one is better.
OBJECTIVE: To compare clinical outcomes of interlocking intramedullary naills and minimally invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults.
METHODS: The PubMed database, Embase database, Cochrane database, CBM database, Wangfang database and CNKI database were searched by computer for the articles on interlocking intramedullary naills and minimally invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults, and the relevant Chinese and English orthopedic journals were hand-searched, including randomized controlled trials and quasi-randomized controlled trials. Then, the retrieved studies were strictly evaluated in accordance with the Cochrane Collaboration criteria, and the evaluation index included operation time, fracture healing time, bone tissue healing-related adverse events, soft tissue healing-related adverse events and tibia functional recovery. Meta-analysis was performed using RevMan 5.1 software.
RESULTS AND CONCLUSION: A total of 7 articles were screened out, including 377 patients, 188 cases in the interlocking intramedullary naill group and 189 in the minimally invasive percutaneous plate osteosynthesis group. The results of meta-analysis showed that there were no statistically significant differences in the operation time [weighted mean difference=0.58, 95% confidence interval (-28.91, 30.07), P=0.97], the incidence of bone tissue healing-related adverse events [relative risk=0.51, 95% confidence interval (0.22, 1.18), P=0.11], and excellent and good rate of postoperative Johnner-Wruhs function evaluation [relative risk =1.03, 95% confidence interval (0.91, 1.17), P=0.63] between two groups. However, compared with interlocking intramedullary naill group, the fracture healing time was shorter in the minimally invasive percutaneous plate group [weighted mean difference=1.99, 95% confidence interval (0.15, 3.83), P=0.03], and the incidence of bone tissue healing-related adverse events was lower [relative risk=1.84, 95% confidence interval (1.03, 3.27), P=0.04]. The results indicate that the Interlocking intramedullary naill and minimally invasive percutaneous plate osteosynthesis has the same effect in the treatment of middle and distal tibial fracture in adults, but minimally invasive percutaneous plate osteosynthesis can shorten the healing time and reduce the incidence of bone tissue healing-related adverse events.

Key words: bone and joint implants, evidence based medicine of bone and joint, orthopedic implants, Interlocking intramedullary naill, minimally invasive percutaneous plate osteosynthesis, middle and distal tibial fracture, Meta-analysis, nonunion, minimally invasive internal fixation, fracture healing, biological fixation

CLC Number:

R318

Zhang Xuan-xuan, Long Teng-fei, Zhang Pi-jun, Zhao Hui, Wang Gang. Interlocking intramedullary nail versus minimally invasive percutaneous plate osteosynthesis in the treatment of middle and distal tibial fracture in adults: A meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(22): 4107-4114.

Figures/Tables 6

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