Effect of minimally invasive percutaneous plates versus interlocking intramedullary nailing in tibial shaft treatment for fractures in adults: a meta-analysis

Guo-Chao He, Hua-Song Wang, Qing-Fu Wang, Zhuang-Hong Chen, Xian-Hua Cai, Guo-Chao He, Hua-Song Wang, Qing-Fu Wang, Zhuang-Hong Chen, Xian-Hua Cai

Abstract

Objective: The aim of this article was to determine the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults.

Method: Literature searches of the Cochrane Library, PubMed, EMBASE, the Chinese Biomedical Literature database, the CNKI database, Wanfang Data, and the Weipu Journal database were performed up to August 2013. Only randomized and quasi-randomized controlled clinical trials comparing the use of percutaneous plates and interlocking intramedullary nails for tibial shaft fractures were included. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards.

Results: Eleven trials were included. Compared with interlocking intramedullary nailing, minimally invasive percutaneous plates shortened fracture healing time and resulted in lower rates of postoperative delayed union and pain. There was no significant difference between the two methods with regard to the rates of excellent and good Johner-Wruh scoring, the rate of reoperation, and other complications.

Conclusions: Overall, insufficient evidence exists regarding the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults. Low-quality evidence suggests that minimally invasive percutaneous plates could shorten fracture healing time, decrease the rate of postoperative delayed union, and decrease pain levels compared with interlocking intramedullary nailing. There is no significant difference between the two groups in terms of functional recovery scores, reoperation, and other complications. Further research that includes high-quality randomized controlled, multicenter trials is required to compare the effects of minimally invasive percutaneous plates versus interlocking intramedullary nailing in the treatment of tibial shaft fractures in adults.

Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Flow chart showing article selection.
Figure 2
Figure 2
Forest plot of comparison: Fix effects meta-analysis comparing the rate of excellent and good of Johner-Wruh scale.
Figure 3
Figure 3
Funnel plot for the comparison of standardized mean differences of fracture healing time demonstrating the evidence of publication bias.

References

    1. McGrath L, Royston S. Fractures of the Tibial Shaft (including Acute Compartment Syndrome) Surgery (Oxford) 2003;21(9):231–5.
    1. Ben-Galim P, Rosenblatt Y, Parnes N, Dekel S, Steinberg EL. Intramedullary fixation of tibial shaft fractures using an expandable nail. Clin Orthop. 2007;(455):234–40.
    1. Krettek C, Schandelmaier P, Miclau T, Tscherne H. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury. 1997;28 Suppl 1:A20–30.
    1. Williams TH, Schenk W. Bridging-minimally invasive locking plate osteosynthesis (Bridging-MILPO): technique description with prospective series of 20 tibial fractures. Injury. 2008;39(10):1198–203.
    1. Yin B, Chen W, Zhang Q, Wang J, Su Y, Xu G, et al. Tibial fracture treated by minimally invasive plating using a novel low-cost, high-technique system. Int Orthop. 2012;36(8):1687–93.
    1. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984–8.
    1. Collinge C, Protzman R. Outcomes of minimally invasive plate osteosynthesis for metaphyseal distal tibia fractures. J Orthop Trauma. 2010;24(1):24–9.
    1. Higgins J, Green S. Cochrane handbook for systematic reviews of interventions Version 5.1.0 [updated March 2011] (Acessed July 15, 2013 at: .)
    1. Moher D, Liberati A, Tetzlaff J Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12.
    1. Müller ME, Nazarian S, Koch P, Schatzker J. The comprehensive classification of fractures of long bones. Springer. (1990) Berlin Heidelberg New York.
    1. Johner R, Wruhs O. Classification of tibial shaft fractures and correlation with results after rigid internal fixation. Clin Orthop 1983 Sep. 178:7–25.
    1. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials. 1996;17(1):1–12.
    1. Hartling L, Ospina M, Liang Y, Dryden DM, Hooton N, Krebs Seida J, et al. Risk of bias versus quality assessment of randomised controlled trials: cross sectional study. BMJ. 2009;339:b4012.
    1. Chen H, Du GZ, Li JJ. A comparative study of treatment of tibial fractures with minimally invasive percutaneous plates and with interlocking intramedullary nails. Guangzhou Medical Journal. 2005;36(2):69–71.
    1. Fernandes HJA, Sakaki MH, Silva JS, Reis FB, Zumiotti AV. Comparative multicenter study of treatment of multi-fragmented tibial diaphyseal fractures with nonreamed interlocking nails and with bridging plates. Clinics. 2006;61(4):333–8.
    1. Chen ZY. A comparison of results between minimally invasive percutaneous plate osteosynthesis and interlocking intramedullary nail for treatment of tibial fractures. Chinese Journal of Primary Medicine and Pharmacy. 2008;15(10):1603–4.
    1. Li QL, Jin HJ, Guo GM. Comparative effect of treatment of tibial fractures with two methods. Chinese Modern Medicine. 2010;17(26):177–8.
    1. Tang X, Ji Y. Effect of the treatment of tibia fracture with minimally invasive percutaneous locking compression plate fixation. Chinese and Foreign Medical Research. 2010;8(14):54–5.
    1. Shi ZL, Jiang YB. A retrospective comparative study of tibial fractures treated by closed reduction with minimally invasive percutaneous plates and with interlocking intramedullary nails. China Foreign Medical Treatment. 2011;30(28):98.
    1. Yan W, Liu CL. Clinical research on the effects of minimally invasive percutaneous plate fixation for the treatment of comminuted tibial fractures. China Journal of Modern Medicine. 2011;21(18):2173–5.
    1. Chen JH, He XZ, Guan DH, Hou ZQ, Luo CQ, Peng CG, et al. A comparative study of treatment of tibial fractures with minimally invasive percutaneous plates and with interlocking intramedullary nails. China Journal of Pharmaceutical Economics. 2012;(6):47–49.
    1. Jiang Z. Effect of treatment of open tibial fracture using minimally invasive percutaneous plate osteosynthesis technique combined with locking compression plates. Chinese Journal of Postgraduates of Medicine. 2012;35(8):49–51.
    1. Zhang QL, He QL. Clinical analysis of the internal fixation treatment of 58 cases tibial fracture with interlocking intramedullary nails and with percutaneous plates. Medical Innovation of China. 2012;9(23):18–20.
    1. Zhou B, Chen Z. Minimally invasive percutaneous plate fixation in treatment of tibial fracture. Medical Journal of Chinese People's Health. 2012;24(11):1327–9.
    1. Borrelli J, Jr, Prickett W, Song E, Becker D, Ricci W. Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study. J Orthop Trauma. 2002;16(10):691–5.
    1. Saldua NS, Kuhn KM, Mazurek MT. Thermal necrosis complicating reamed intramedullary nailing of a closed tibial diaphysis fracture: a case report. J Orthop Trauma. 2008;22(10):737–41.
    1. Hasenboehler E, Rikli D, Babst R. Locking compression plate with minimally invasive plate osteosynthesis in diaphyseal and distal tibial fracture: a retrospective study of 32 patients. Injury. 2007;38(3):365–70.
    1. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002;84(8):1093–110.
    1. Braten M, Helland P, Grontvedt T, Aamodt A, Benum P, Molster A. External fixation versus locked intramedullary nailing in tibial shaft fractures: a prospective, randomised study of 78 patients. Arch Orthop Trauma Surg. 2005;125(1):21–6.
    1. Roberts C, Torgerson D. Randomisation methods in controlled trials. BMJ. 1998;317(7168):1301.
    1. Vallier HA, Cureton BA, Patterson BM. Factors influencing functional outcomes after distal tibia shaft fractures. J Orthop Trauma. 2012;26(3):178–83.
    1. Rosenthal R, DiMatteo MR. Meta-analysis: recent developments in quantitative methods for literature reviews. Annu Rev Psychol. 2001;52:59–82.

Source: PubMed

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