Intramedullary nailing versus plate fixation for the treatment of proximal tibia extra-articular fractures: a...

The incidence of proximal tibia extra-articular fractures is fairly common accounting for approximately 5-11% of all tibia fractures (Lang in Clin Orthop Relat Res 315:64-74, 1995; Freedman in Clin Orthop Relat Res 315:25-33, 1995). The optimal treatment method for these fractures between intramedullary nailing and proximal locking plate remains equivocal. The purpose of this meta-analysis is to assess the clinical, radiological, and functional outcomes as well as the complications in adult patients with extra-articular proximal tibia fractures treated with IMN or PLP.

We performed a systematic literature search identifying comparative studies meeting the above criteria and published from January 2000 to May 2024 from four databases: MEDLINE, EMBASE, Google Scholar, and Cochrane Library. We performed the meta-analysis in accordance with PRISMA guidelines, and the study was prospectively registered on PROSPERO.

Of the 761 studies identified, nine (9) met our inclusion criteria. Six hundred and sixty-two patients (320 IMN and 342 PLP) were evaluated with a minimum follow-up of 12 months. IMN demonstrated a lower union time [OR = - 2.83, 95% CI: - 4.8-0.87, p = 0.005, I² = 73%] and infection rate [OR 0.49, 95%: 0.27-0.92, p = 0.03, I² = 0%], while the PLP group had a lower incidence of anterior knee pain [5.07, 95% CI: 1.77-14.48, p = 0.002, I² = 0%]. No significant difference was noted in terms of non-union, malunion, delayed union rate, revision rate, knee ROM, malalignment, operative time, and hospital stay.

IMN demonstrated shorter union time and risk of infection, while LP fixation displayed significantly lower risk for anterior knee pain. Although successful results can be achieved with both implants, further research is required on this topic to provide definitive evidence.