Comparison of intramedullary nailing and plate fixation in distal tibial fractures with metaphysical damage: a meta-analysis of randomized controlled trials
1Dr Abdul Basit, 2Dr Muhammad Arshad Ghani, 3Dr Yasir Mustafa, 4Dr Rouf ul Islam Sheikh
4Pakistan institute of medical sciences Islamabad).
Vol 4, No 3. Pp. 751-759.
Submission: 20 July 2025 | Acceptance: 25 September 2025 | Publication: 11 November 2025
Abstract
Background: Distal metadiaphyseal tibial fractures are commonly seen lower limb fractures. Intramedullary nail fixation (IMN) and plate internal fixation (PL) are the two mainstay treatments for tibial fractures, but agreement on the best internal fixation for distal tibial fractures is still controversial. This meta-analysis was designed to compare The success of IMN and PL fixations in the treatment of distal metadiaphyseal tibial fractures, in terms of complications and functional recovery. Methods: Randomize Controlled Trial RCT at Jinnah Hospital Lahore 2024-2025. Results: Eleven studies were included in the current meta-analysis. A significant difference in malunion (RR = 1.76, 95%CI 1.21–2.57, P = 0.003), superficial infection (RR = 0.29, 95%CI 0.13–0.63, P = 0.002), FFI (MD = 0.09, 95%CI 0.01– 0.17, P = 0.02), and knee pain (RR = 3.85, 95%CI 2.07–7.16, P < 0.0001) was noted between the IMN group and PL group. No significant difference was seen in the operation time (MD = – 10.46, 95%CI – 21.69–0.77, P = 0.07), radiation time (MD = 7.95, 95%CI – 6.65–22.55, P = 0.29), union time (MD = – 0.21, 95%Cl – 0.82–0.40, P = 0.49.), nonunion (RR = 2.17,95%CI 0.79–5.99, P = 0.15), deep infection (RR = 0.85, 95%CI 0.35–2.06, P = 0.72), delay union (RR = 0. 92, 95%CI 0.45–1.87, P = 0.82), AOFAS (MD 1.26, 95%Cl – 1.19–3.70, P = 0.31), and Disability Rating Index in 6 or 12 months (MD = – 3.75, 95%CI – 9.32–1.81, P = 0.19, MD = – 17.11, 95%CI – 59.37–25.16, P = 0.43, respectively). Conclusions: Although no significant difference was seen between IMN and PL fixation with regards to the operation time, radiation time, nonunion, deep infection delay union, union time, AOFAS, and Disability Rating Index, significant differences were seen in occurrence of malunion, superficial infection, FFI, and knee pain. Based on this evidence, IMN appears to be a superior choice for functional improvement of the ankle and reduction of postoperative wound superficial infection. Keywords: Comparison, intramedullary, nailing, plate fixation, distal tibial fractures, metaphysical damage, meta-analysis, randomized controlled trials.
