الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
Abstract
IM nailing and MIPPO fixation remain viable options for management of distal tibia fractures. IM nailing provides superior operation time, union time, and time to full weight-bearing as well as a lower incidence of superficial and deep infection, but may provide inferior alignment and is associated with residual knee pain. MIPPO fixation provides superior alignment and avoids knee pain, but it has a higher rate of soft-tissue complications and hardware irritation.
This review revealed that MIPPO has a higher risk of both superficial and deep infection among patients treated with MIPPO compared to IMN. In the MIPPO technique, 15% developed a superficial infection, compared to 7% after IMN, and 14% developed a deep infection, compared to 6.3% after IMN.
In terms of union complication, IMN has a higher incidence of mal-union which occurred in 14.7% of the patients after IMN compared to 8.8% after MIPPO fixation. The incidence of non-union was similar in both treatment methods, it occurred in 3.5% of patients. In addition to union rate, the union time was significantly shorter after IMN fixation compared to the MIPPO technique especially in AO 43A fracture type and the closed fractures. The mean time for union was 18 weeks in IMN compared to 20 weeks in MIPPO.
Anterior knee pain was frequently reported after IMN fixation. It was found in 28% of cases versus no cases in MIPPO fixation.
About secondary operations, both treatment methods have a high incidence of secondary operations with no significant difference between them. Secondary operations were required in 25% of the IMN method and 30% in the MIPPO fixation method.
The full weight-bearing time was significantly faster after IMN fixation compared to MIPPO fixation with approximately two weeks.
Regarding the intra-operative data, the operation time was significantly shorter for IMN in comparison to the MIPPO method (74.1 minutes versus 85.4 minutes). The pooled data about radiation time showed no significant difference between both treatment methods.
About the functional outcome, both IMN and MIPPO have no difference in the quality-of-life score and functional scores but, MIPPO was superior to IMN in AOFAS score.
Chapter 7
CONCLUSION
Based on this study, both MIPPO and IMN have similar therapeutic efficacy regarding the functional outcome and can be used safely in distal tibial extra-articular fractures. Although IMN is advantageous over MIPPO with a lower incidence of infection and implant irritation symptoms, shorter operation time, earlier weight-bearing, and earlier union, it leads to a higher rate of mal-union and anterior knee pain.
Overall, choosing an implant based on the findings of this meta-analysis is difficult and should be done on a case-by-case basis. Patients who have a high risk for infection (due to high age, comorbidities, smoking, or severe soft tissue injury) should preferably be treated with a nail. MIPPO fixation may be more beneficial to young, active, and healthy patients who are less prone to infection because it reduces the risk of knee pain and mal-union.