BACKGROUND The treatment for distal tibial fractures remains controversial to date. Minimally invasive percutaneous plate osteosynthesis (MIPPO) and intramedullary nailing (IMN) are well-accepted and effective methods for distal tibial fractures, but these methods were associated with complications. This study aimed to assess and compare the clinical and functional outcomes in patients with distal tibial fractures treated with MIPPO or IMN. METHODS We systematically reviewed randomized controlled trials (RCTs) that compared MIPPO with IMN in patients with distal tibial fractures from inception till 15 August 2019. Also, quantitative summaries of time to reunion, rate of complications, and functional outcomes were evaluated. RESULTS The pooled results suggested that patients in the MIPPO group had a longer time to reunion with a mean difference of 1.21 weeks [P = 0.02; 95% confidence interval (CI) 0.16-2.26)] than those in the IMN group. The overall union complications and deep infection between IMN and MIPPO were similar (P > 0.05). IMN had a significantly low risk of wound complications [risk ratio (RR) = 0.51, P = 0.00, 95% CI 0.34-0.77)]. The pooled functional outcomes of the two groups remained controversial by different evaluating scores. CONCLUSIONS Compared to MIPPO, IMN had a significantly low risk of wound complications and associated with limited time for reunion. Although the pooled functional outcomes of the two groups were controversial due to different evaluating scores, IMN was the preferred surgical technique than MIPPO for treating distal tibial fractures.

中文翻译：

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微创经皮钢板内固定与髓内钉固定治疗胫骨远端骨折：系统评价和荟萃分析。

背景技术迄今为止，对于胫骨远端骨折的治疗仍存在争议。微创经皮钢板内固定（MIPPO）和髓内钉（IMN）是胫骨远端骨折的公认且有效的方法，但这些方法与并发症相关。这项研究旨在评估和比较MIPPO或IMN治疗的远端胫骨骨折患者的临床和功能结局。方法我们系统回顾了随机对照试验（RCT），该试验比较了从开始到2019年8月15日胫骨远端骨折患者的MIPPO和IMN。还评估了重聚时间，并发症发生率和功能结局的定量总结。结果汇总的结果表明，MIPPO组患者的团聚时间更长，平均差异为1.21周[P = 0.02； P = 0.02； P = 0.02。95％置信区间（CI）0.16-2.26）]。IMN和MIPPO之间的总的联合并发症和深层感染相似（P> 0.05）。IMN的伤口并发症风险极低[风险比（RR）= 0.51，P = 0.00，95％CI 0.34-0.77）。两组合并的功能结局因不同的评估分数而存在争议。结论与MIPPO相比，IMN发生伤口并发症的风险明显较低，并且团聚时间有限。尽管由于评估得分不同，两组的综合功能结局存在争议，