Abstract
Purpose
The purpose of this meta-analysis is to analyse the literature on plate-assisted reduction during intramedullary nailing of tibial shaft fractures and to compare the rates of infection and nonunion.
Methods
The databases Medline, Embase, and Web of Science were searched from inception to February 2022 for literature comparing plate-assisted reduction during intramedullary nailing of extra-articular tibia fractures to standard, closed means of reduction. Data were extracted and pooled in a random effects meta-analysis for the primary outcomes of nonunion and infection risk.
Results
Five comparative studies were identified including 520 total patients, of which 151 underwent tibial nailing with the use of plate-assisted reduction with an average follow-up time of 17.9 months. Approximately two-thirds of patients retained the plate used to assist reduction during intramedullary nailing (102 of 151). Pooled analysis of the infection rates found no significant difference with plate-assisted intramedullary nailing (Risk Ratio [RR] 0.90, 95% CI 0.49–1.65, p = 0.72), and for nonunion rates, there was also no significant difference with plate-assisted intramedullary nailing (Risk Ratio [RR] 0.80, 95% CI 0.40–1.60, p = 0.53).
Conclusions
Plate-assisted reduction during intramedullary nailing of tibia shaft fractures was not associated with an increased risk for nonunion or infection, and can be safely applied as an adjunct for reduction in challenging fracture patterns, without the need for later removal. However, evidence is quite limited and further investigation into the use of provisional plating as a technique is needed as its use in intramedullary nailing continues to expand.
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References
Court-Brown CM, McBirnie J (1995) The epidemiology of tibial fractures. J Bone Jt Surg - Ser B 77:417–421. https://doi.org/10.1302/0301-620x.77b3.7744927
Larsen P, Elsoe R, Hansen SH et al (2015) Incidence and epidemiology of tibial shaft fractures. Injury 46:746–750. https://doi.org/10.1016/j.injury.2014.12.027
Court-Brown CM, Bugler KE, Clement ND et al (2012) The epidemiology of open fractures in adults. A 15-year review. Injury 43:891–897. https://doi.org/10.1016/j.injury.2011.12.007
Weber CD, Hildebrand F, Kobbe P et al (2019) Epidemiology of open tibia fractures in a population-based database: update on current risk factors and clinical implications. Eur J Trauma Emerg Surg 45:445–453. https://doi.org/10.1007/s00068-018-0916-9
Bhandari M, Guyatt G, Walter SD et al (2008) Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Jt Surg 90:2567–2578. https://doi.org/10.2106/JBJS.G.01694
Kyengera DK, O’Hara NN, Slobogean GP et al (2022) Unreamed intramedullary nailing versus external fixation for the treatment of open Tibial shaft fractures in Uganda. J Orthop Trauma Publish Ah. https://doi.org/10.1097/bot.0000000000002362
Yoon RS, Liporace FA (2016) Intramedullary nail and plate combination fixation for complex distal tibia fractures: When and how? J Orthop Trauma 30:S17–S21. https://doi.org/10.1097/BOT.0000000000000698
Yoon RS, Gage MJ, Donegan DJ, Liporace FA (2015) Intramedullary nailing and adjunct permanent plate fixation in complex tibia fractures. J Orthop Trauma 29:e277–e279. https://doi.org/10.1097/BOT.0000000000000299
Nork SE, Barei DP, Schildhauer TA et al (2006) Intramedullary nailing of proximal quarter tibial fractures. J Orthop Trauma 20:523–528. https://doi.org/10.1097/01.bot.0000244993.60374.d6
Behlmer RJ, Whiting PS, Kliethermes SA et al (2021) Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study. OTA Int Open Access J Orthop Trauma 4:e095. https://doi.org/10.1097/oi9.0000000000000095
Krettek C, Stephan C, Schandelmaier P et al (1999) The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Jt Surg - Ser B 81:963–968. https://doi.org/10.1302/0301-620X.81B6.10000
Archdeacon MT, Wyrick JD (2006) Reduction plating for provisional fracture fixation. J Orthop Trauma 20:206–211. https://doi.org/10.1097/00005131-200603000-00007
Dunbar RP, Nork SE, Barei DP, Mills WJ (2005) Provisional plating of type III open tibia fractures prior to intramedullary nailing. J Orthop Trauma 19:412–414
Auston DA, Meiss J, Serrano R et al (2017) Percutaneous or open reduction of closed Tibial shaft fractures during intramedullary nailing does not increase wound complications, infection or nonunion rates. J Orthop Trauma 31:215–219
Moher D, Shamseer L, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1–9. https://doi.org/10.1186/2046-4053-4-1
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159. https://doi.org/10.2307/2529310
Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (Minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x
Shah A, Kay J, Memon M et al (2019) What makes suture anchor use safe in hip arthroscopy? A systematic review of techniques and safety profile. Arthroscopy 35:1280–1293. https://doi.org/10.1016/j.arthro.2018.10.118
Higgins J, Green S (2011) Cochrane Handbook: Cochrane Reviews of Interventions. In: Cochrane Handbook for: Systematic Reviews of Interventions. pp 3–10
Cinats DJ, Perey B, Moola F et al (2020) Plate-assisted intramedullary nailing of proximal third tibia fractures. J Orthop Trauma 34:321–326. https://doi.org/10.1097/BOT.0000000000001721
Haller JM, Githens M, Scolaro J, Firoozabadi R (2017) Does provisional plating of closed tibia fractures have higher complication rates? J Orthop Trauma 31:554–558. https://doi.org/10.1097/BOT.0000000000000874
Ludwig M, Hymes RA, Schulman J et al (2016) Intramedullary nailing of open tibial fractures: provisional plate fixation. Orthopedics 39:e931–e936. https://doi.org/10.3928/01477447-20160623-08
Revak T, Mahle P, Nicolaou D, Watson JT (2021) Permanent reduction plate and intramedullary nailing of open tibia fractures: Do we need to take them out? Injury 52:2439–2443. https://doi.org/10.1016/j.injury.2021.03.056
Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium - 2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21:S1-133
Bishop JA, Dikos GD, Mickelson D, Barei DP (2012) Open reduction and intramedullary nail fixation of closed tibial fractures. Orthopedics 35:e1631–e1634. https://doi.org/10.3928/01477447-20121023-21
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Gouveia, K., Hache, P. & Johal, H. Plating as a reduction aid prior to intramedullary nailing of tibia fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 34, 1259–1267 (2024). https://doi.org/10.1007/s00590-023-03801-w
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DOI: https://doi.org/10.1007/s00590-023-03801-w