Intramedullary Nailing Versus Plating for Proximal Tibia Fractures: A Systematic Review and Meta-analysis
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REVIEW ARTICLE
Intramedullary Nailing Versus Plating for Proximal Tibia Fractures: A Systematic Review and Meta‑analysis Karan Jindal1 · Deepak Neradi1 · Praveen Sodavarapu1 · Deepak Kumar1 · Akshay Shetty1 · Vijay Goni1 Received: 1 June 2020 / Accepted: 26 October 2020 © Indian Orthopaedics Association 2020
Abstract Introduction Extra-articular proximal tibia fractures make up to one-tenth of all tibia shaft fractures. Treatment options include conservative, nailing, plating and external fixation. There is no consensus on which method is superior if the patient is to be managed surgically. Materials and Methods We conducted a systematic review and meta-analysis to know which definitive surgical treatment option (nailing or plating) is better for extra-articular proximal tibia fracture. We used search engines like PubMed, Embase, Scopus, Ovid Medline and Google Scholar to find articles comparing the results of nailing versus plating. We could identify only 4 articles regarding this and data was extracted and meta-analysis was done. Results Delayed union was common in the nailing group with odds ratio of 8.29 favoring the plating group (95% CI 1.77, 38.80, p = 0.007) while malunion showed no difference in both groups. Rate of infection was higher in the plating group while anterior knee pain was common in the nailing group with odds ratio of 5.54 favoring the plating group (95% CI 1.49, 13.88, p = 0.008). Range of motion showed no difference between both groups, fractures in the nailing group united early and the difference was significant (p = 0.005, odds ratio – 4.48) (95% CI – 8.29, – 1.47).The surgical duration was less in the nailing group but was not significant. Conclusion Considering lesser time for union, early weight bearing, lower chances of infection and lesser surgical duration, nailing seems to be more promising for extra articular proximal tibia fractures. Further research is required on this topic to provide a definitive evidence. Keywords Extra-articular proximal tibia · Fracture · Nailing · Plating · Malunion · Infection · Knee pain
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s43465-020-00304-2) contains supplementary material, which is available to authorized users. * Deepak Neradi [email protected] Karan Jindal [email protected] Praveen Sodavarapu [email protected] Deepak Kumar [email protected] Akshay Shetty [email protected] Vijay Goni [email protected] 1
Department of Orthopaedics, PGIMER, Chandigarh, India
Extra-articular fractures in proximal tibia are seen in up to one-tenth of all tibial shaft fractures and generally result from high-velocity trauma [1]. Non operative treatment of these fractures has frequently resulted in malunion, nonunion, or stiffness of adjacent joints [2–4]. Surgical management options for these fractures include intramedullary fixation, plating, mono-lateral or circular external fixation, or a combination of any of these techniques [5]. In recent times, pl
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