ABSTRACT
To evaluate the outcome of intramedullary nail and plate fixation for the treatment of extra-articular fractures of the distal tibia and to determine whether there are sufficient objective data in the literature to compare the two methods. A comprehensive search of all relevant articles from Jan 1975 to Dec 2011 was conducted. Two reviewers evaluated each study to determine its suitability for inclusion and collected the data of interest. Meta-analytic pooling of group results across studies was performed for the two treatment methods. The systematic review identified 22 primary studies with 880 fractures including 15 groups of intramedullary nail and 15 groups of plate. For extra-articular distal tibia fractures, shorter healing time can be achieved by using the intramedullary nail, but the malformation rate was significantly higher than in the plate group. The average operating time in the intramedullary nail group was longer than in the plate group, but the difference was not statistically significant. No statistically significant difference was found when comparing the rates of infection, rotation, shortening, delayed union and nonunion. The reoperation rate was higher in the intramedullary nail group compared with the plate group, but the difference was also not statistically significant. The functional and efficacy outcomes appear to be similar between the two treatment groups. Thus the patient's general condition and the surgeon's preference dictate the choice of surgical technique
ABSTRACT
<p><b>BACKGROUND</b>There is lack of consensus regarding the best option for the treatment of acute Achilles tendon rupture-operation or non-operation. The purpose of this meta-analysis was to identify and summarize the randomized controlled trials comparing the operative and non-operative lines of treatment of acute Achilles tendon ruptures.</p><p><b>METHODS</b>We searched multiple databases in English (including EMBASE, PubMed, and OVID) and in Chinese (including CNKI, WANFANG, and VIP), as well as reference lists of articles and main orthopaedic and sports medical journals. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by RevMan 5.0 software.</p><p><b>RESULTS</b>Eight randomized controlled trials (RCTs) involving 777 patients met the inclusion criteria. The rerupture rate in non-operative group was significantly higher (Z = 3.33, P < 0.01). However, the moderate (Z = 4.27, P < 0.01) and minor (Z = 5.59, P < 0.01) complication rate in the operative group were significantly higher. No significant difference in comparing the major and total complication rates. The return to work time in the operative group was shorter (Z = 2.65, P < 0.01). The inability to return to previous level sporting rate and ankle joint decreased range of motion (ROM) rate showed no significant difference in the two groups. Other functional outcomes were similar in the two groups.</p><p><b>CONCLUSIONS</b>Operation could significantly reduce the risk of rerupture; however, it was associated with a higher risk of other complications. The functional outcomes were similar in two treatment methods except an earlier return to work in patients treated operatively. Thus operative treatment is preferable for patients with good physical condition. Non-operative treatment is an acceptable alternative especially for the older and patients with lower sporting requirements.</p>