Plate Fixation Versus Intramedullary Nailing for Both-Bone Forearm Fractures: A Meta-analysis of Randomized Controlled Trials and Cohort Studies

Abstract

Objective: The aim of this study was to compare the radiographic and functional outcomes of operative intervention in patients with both-bone forearm fractures treated by open reduction and internal fixation (ORIF) with plates or intramedullary (IM) nailing.

Methods: Studies published in PubMed, EMBASE, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and CNKI (China National Knowledge Infrastructure, China) were systematically searched. The main outcomes included time to union, union rate, operation time, magnitude and location of radial bow, loss of forearm rotation, and complication rates. Results were expressed with weighted mean difference or risk ratio with 95 % confidence intervals. Pooled estimates were calculated using a fixed-effects or random-effects model according to the heterogeneity among studies.

Results: A total of 13 studies met the inclusion criteria and were included in this meta-analysis. Compared with ORIF, IM nailing significantly reduced the operation time and complication rate. However, no significant differences were observed between the two surgical techniques in several outcomes, including time to union, union rate, radial bow magnitude, and loss of forearm rotation. Except in complications, these findings were consistent across the subgroup analysis of children and adult patients.

Conclusion: IM nailing is associated with shorter operation time and lower complication rate compared with ORIF. It is an effective and safe treatment option for children and adults with both forearm fractures. However, considering the limitations in this study, large-scale, high-quality randomized controlled trials are needed to indentify these findings.