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Review
. 2025 Sep 22;33(5):e290433.
doi: 10.1590/1413-785220253305e290433. eCollection 2025.

SURGICAL TREATMENT OF TIBIAL STRESS FRACTURE: NAIL X PLATE

Paulo Henrique Schmidt Lara  1 , Guilherme Leme Cabello  1 , Danilo Cabral Domingues  1 , Daniel Costa Bezerra  1 , Antônio Bezerra de Albuquerque  1 , Paulo Santoro Belangero  1
Affiliations
Review

SURGICAL TREATMENT OF TIBIAL STRESS FRACTURE: NAIL X PLATE

Paulo Henrique Schmidt Lara et al. Acta Ortop Bras. .

Abstract
in English, Portuguese

To analyze and compare two surgical treatment methods for tibial stress fractures: intramedullary nailing and tension plate, taking into account functional outcomes and postoperative results. This systematic review was conducted and written in accordance with the guidelines for systematic reviews - PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The bibliographic search was carried out between January and September 2024 in journals indexed in the PubMed, Lilacs, Cochrane and Embase databases. Ten studies were selected. Among them, five were case reports, four were case series, and one was a retrospective cohort study. Intramedullary nailing offers good stabilization and a gradual return to sports activities, but it can cause complications such as knee pain and additional fractures. The anterior tension plate, on the other hand, provides effective stabilization with less anterior knee pain and faster healing times, but it is more invasive and may require implant removal and intensive rehabilitation. The choice between intramedullary nailing and tension plate should be based on a detailed assessment of the individual characteristics of the patient, the nature of the fracture, and the potential risks associated with each technique. Level of Evidence IIA; Systematic Review of Cohort Studies.

Analisar e comparar dois métodos de tratamento cirúrgico para fratura por estresse da tíbia: haste intramedular e placa de tensão, levando em consideração os desfechos funcionais e resultados pós-operatórios. A presente revisão sistemática foi conduzida e redigida de acordo com as diretrizes para revisões sistemáticas – PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A pesquisa bibliográfica foi realizada entre janeiro e setembro de 2024 nos periódicos indexados nas bases de dados PubMed, Lilacs, Cochrane e Embase. Dez estudos foram escolhidos. Dentre eles cinco relatos de caso, quatro séries de casos, e um estudo coorte retrospectivo. A haste intramedular oferece boa estabilização e um retorno gradual às atividades esportivas, porém pode causar complicações como dor no joelho e fraturas adicionais. A placa de tensão anterior, por sua vez, proporciona uma estabilização eficaz com menor dor anterior no joelho e tempos de consolidação mais rápidos, mas é mais invasiva e pode exigir a remoção do implante e reabilitação intensiva. A escolha entre a haste intramedular e a placa de tensão deve ser baseada em uma avaliação detalhada das características individuais do paciente, da natureza da fratura e dos riscos potenciais associados a cada técnica. Nível de evidência IIA; Estudo de Revisão Sistemática de Estudos Coorte.

Keywords: Fracture Fixation, Intramedullary; Stress Fracture; Tibia.

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Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. Flowchart of the search for articles in databases.
See this image and copyright information in PMC

References

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