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Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for closed distal tibial fractures: a meta-analysis of the clinical outcomes

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Title: Minimally invasive percutaneous plate osteosynthesis versus intramedullary nail fixation for closed distal tibial fractures: a meta-analysis of the clinical outcomes
Authors: Goh, EL
Chidambaram, S
Eigenmann, D
Ma, S
Jones, GG
Item Type: Journal Article
Abstract: Introduction: Minimally invasive percutaneous plate osteosynthesis (MIPPO) has emerged as a viable alternative for the treatment of distal tibial fractures. However, the clinical outcomes of this procedure compared to intramedullary (IM) nail fixation have yet to be established. The present meta-analysis aims to compare the clinical outcomes following MIPPO and IM nail fixation for closed distal tibial fractures. Methods: MEDLINE and EMBASE databases were searched from date of inception to 10th April 2017. Randomized controlled trials (RCTs) comparing MIPPO with IM nail fixation for closed and Gustilo Grade I distal tibial fractures were included. Outcomes assessed included time to union, complications and functional outcomes. Quality and risk of bias of the RCTs were assessed using the Cochrane Collaboration Tool. Results: Five RCTs comprising 497 patients were included. MIPPO was associated with a longer time to union (MD: 1.08, 95% CI: 0.26, 1.90, p = 0.010, I 2 = 84%) and increased risk of wound complications (RR: 1.58, 95% CI: 1.01, 2.46, p = 0.04, I 2 = 0%). Both MIPPO and IM nail fixation had comparable risks of malunion, delayed union, non-union and deep infections, with similar functional outcomes. Discussion: Compared to IM nail fixation, a MIPPO fixation technique for distal tibial fractures is associated with a longer time to fracture union and an increased risk of wound complications. Neither technique demonstrates a clear advantage with regard to risk of malunion/non-union, or functional outcome. Assuming equivalent surgical expertise with both techniques, the results suggest that IM nail fixation is the treatment modality of choice for these challenging fractures.
Issue Date: 18-Dec-2018
Date of Acceptance: 19-Nov-2018
URI: http://hdl.handle.net/10044/1/66934
DOI: https://dx.doi.org/10.1051/sicotj/2018055
ISSN: 2426-8887
Publisher: EDP SCIENCES S A
Journal / Book Title: SICOT-J
Volume: 4
Copyright Statement: © 2018 The Authors, published by EDP Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Science & Technology
Life Sciences & Biomedicine
Orthopedics
Distal Tibial Fractures
Plate
Intramedullary Nail
Meta-Analysis
Clinical Outcomes
SHAFT FRACTURES
ADULTS
TRIAL
Publication Status: Published
Open Access location: https://www.sicot-j.org/articles/sicotj/abs/2018/01/sicotj180072/sicotj180072.html
Article Number: 58
Appears in Collections:Division of Surgery



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