Plate versus nail for distal tibial fractures: a systematic review and meta-analysis.

OBJECTIVES: To undertake a systematic review to determine whether there are advantages in using plate or nail fixation for distal meta-diaphyseal tibial fractures with or without articular involvement. DATA SOURCES: Searches using MEDLINE, EMBASE, and Cochrane library. STUDY SELECTION: Studies of parallel group design comparing plate or nail fixation for distal tibial fractures. DATA EXTRACTION: Information on study methods and outcomes. DATA SYNTHESIS: We conducted random effects meta-analysis to evaluate risk of nonunion or delayed union, wound complications and superficial infection, deep infection, and fracture malalignment. RESULTS: We found 8 studies (n = 455, 4 prospective randomized and 4 retrospective cohort) that evaluated plate compared with nail for distal tibial fractures. No significant difference was found between the use of a plate and nail regarding bone union complications [plate, 5.4%; nail, 8.3%; odds ratio (OR), 0.66; 95% confidence interval (CI), 0.28-1.54; I = 0%; P = 0.34], wound complications including superficial infection (plate, 7.9%; nail, 3.2%; OR, 1.83; 95% CI, 0.40-8.46; I = 48%; P = 0.44), and deep infection (plate, 3.5%; nail, 2.8%; OR, 1.32; 95% CI, 0.44-3.91; I = 0%; P = 0.62). We found a significantly reduced risk of fracture malalignment with the use of a plate compared with a nail (plate, 8.7%; nail, 24.9%; OR, 0.33; 95% CI, 0.17-0.64; I = 0%; P = 0.001). CONCLUSIONS: Plate fixation compared with intramedullary nailing is associated with a reduced risk of fracture malalignment with no differences in bone union, wound complications, and superficial infection or deep infection. Current evidence might recommend plate over nail unless there are concerns with the soft tissues. Additional larger scale multicentre randomized controlled trials are required to clarify these issues.