SynthesisJournal of orthopaedic surgery and research2025
Intramedullary nailing versus minimally invasive plate osteosynthesis (MIPO) for proximal tibial fracture: a systematic review and meta-analysis.
Synthesis in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- [Treatment options and research progress of proximal tibial extra-articular fractures].Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery · 2025Review
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6 authors.
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Abstract
purposeTo compare intramedullary nailing (IMN; suprapatellar, infrapatellar, or parapatellar) with minimally invasive plate osteosynthesis (MIPO) for proximal tibial fractures by systematically evaluating clinical outcomes. MATERIALS AND
methodsWe included English-language randomized controlled trials (RCTs) and comparative studies evaluating adult proximal tibial fractures (AO/OTA 41-A2/A3, 41-C1/C2) treated with IMN or MIPO. Databases including PubMed, Embase, Cochrane, and Scopus were searched until June 9, 2025. Study selection, data extraction, and quality assessment were independently performed by two reviewers. Statistical analyses were conducted using STATA version 18.0. Dichotomous outcomes were expressed as risk ratios (RR) or odds ratios (OR), and continuous outcomes as weighted mean differences (WMD) or standardized mean differences (SMD), each with 95% confidence intervals (CI). Heterogeneity was assessed using I² statistic and Cochran's Q test, applying a random-effects model if I² >50% or p < 0.1. Publication bias was evaluated via funnel plots and Egger's regression test.
resultsEleven studies comprising 829 patients (409 IMN; 420 MIPO) met the inclusion criteria. The IMN group demonstrated a significantly lower infection rate compared with the MIPO group (RR = 0.55; 95% CI, 0.33-0.91; p = 0.019). Conversely, traditional (infrapatellar and parapatellar) IMN approaches showed significantly increased anterior knee pain incidence compared to MIPO (RR = 6.27; 95% CI, 0.92-20.55; p = 0.002). Suprapatellar IMN studies did not report anterior knee pain outcomes. No significant differences were identified between IMN and MIPO in nonunion rates (RR = 1.04; 95% CI, 0.61-1.77; p = 0.88), malalignment incidence (RR = 1.29; 95% CI, 0.88-1.89; p = 0.19), knee range of motion (WMD = 0.08; 95% CI, -2.22-2.37; p = 0.95), or implant removal rates (RR = 0.69; 95% CI, 0.41-1.15; p = 0.16).
conclusionIMN fixation for proximal tibial fractures significantly reduces infection risk compared with MIPO surgery, but traditional IMN approaches (infrapatellar/parapatellar) carry a greater risk of anterior knee pain. No differences were observed in nonunion rates, malalignment, knee range of motion, or implant removal rates between the two treatments. Further high-quality studies evaluating suprapatellar IMN approaches are warranted.
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