Objective To systematically review the clinical efficacy and complications of in-tramedullary nailing (IMN) versus plating for distal tibia fractures in adults. Methods A comprehensive search was conducted for the randomized controlled trials from January 2005 to October 2016 on the IMN versus plating for distal tibia fractures in The Cochrane Library, Springer, Pubmed, Medline Embase, CNKI, Wanfang Data and manually as well. The quality of the included literature was evaluated accordingly. RevMan5.3 provided by Cochrane was used to analyze the data. Results A total of 7 randomized con-trolled trials (n=514) were included involving 514 participants (IMN: 267; Plating: 247). IMN achieved a significantly lower superficial infection incidence [MD=2.41, 95% CI (1.11, 5.23), P=0.03]. There were no significant differences between IMN and plating in deep infection [MD=1.43, 95% CI (0.51, 4.04), P=0.50], nonunion [MD=1.35, 95% CI (0.56, 2.38), P=0.51], malunion [MD=0.88, 95% CI (0.50, 1.57), P=0.67], delayed union [MD=0.69, 95% CI (0.26, 1.85), P=0.46],or removal of metal work [MD=1.05, 95% CI (0.81, 1.36), P=0.72]. Conclusion Since plating may lead to a significantly higher rate of superficial infection for adult distal tibial fractures than intramedullary nailing, special attention should be paid to aseptic manipulation during plating, and minimally invasive pro-cedures and soft tissue protection measures should be taken as far as possible.

OBJECTIVE: To investigate the incidence of lower extremity deep vein thrombosis (DVT) before surgery in patients with spinal fracture and analyze its risk factors. METHODS: The clinical data of 1 046 patients with spinal fracture who underwent surgery from October 2017 to December 2020 were retrospectively analyzed, including patient's age, gender, body mass index (BMI), smoking history, complications, the time from injury to diagnosis of DVT, blood index results on admission. The complications included hypertension, osteoporosis, diabetes, coronary heart disease, chronic obstructive pulmonary disease (COPD), anemia, obesity, hypokalemia, hyponatremia, hypoproteinemia, renal insufficiency, spinal cord injury;blood index results on admission included hematocrit (HCT), creatinine (Cre), triglyceride (TG), high-density lipoprotein (HDL), low-density lipoprotein(LDL), D-dimer(D-D), fibrin/fibrinogen degradation products(FDP), and C-reactive protein(CRP). The patients were divided into group according to whether DVT was diagnosed by the lower extremity venous ultrasonography after admission to pre-operation. The patients with DVT were set as the DVT group, and the patients without DVT were set as the non-DVT group. First, the above-mentioned possible risk factors were analyzed by univariate analysis, and then the risk factors of DVT before spinal fracture surgery were analyzed by multivariate Logistic regression. RESULTS: Among 1 046 patients with spinal fracture, 137 had DVT before operation and 909 had no DVT. There were significant differences in age, the incidence of preoperative osteoporosis, diabetes, anemia, hypoalbuminemia, the levels of LDL, plasma D-D, FDP, and CRP between the two groups (P<0.05). Multivariate Logistic regression analysis showed that osteoporosis (OR=3.116, 95%CI:1.816-5.346, P<0.001), hypoproteinemia (OR=2.508, 95%CI:1.583-3.974, P<0.001), preoperative serum LDL>4.645 mmol/L(OR=2.586, 95%CI:1.394-4.798, P<0.001), plasma D-D>558.00 ng/ml (OR=23.916, 95%CI:15.108-37.860, P<0.001), FDP>13.81 µg/ml(OR=3.873, 95%CI:2.614-5.739, P<0.001) and age were independent risk factors for the occurrence of DVT before spinal fracture surgery, and the incidence of DVT in patients aged 36-50, 51-65 and over 65 years was 2.49, 2.59 and 4.02 times of those aged 18-35 years, respectively. CONCLUSION The incidence of preoperative DVT in patients with spinal fracture is 13.10%(137/1 046). Preoperative complicating osteoporosis, hypoalbuminemia, serum LDL>4.645 mmol/L, plasma D-D> 558.00 ng/ml, FDP> 13.81 µg/ml and age are risk factors for DVT. And the older the patient, the higher the risk of DVT.
Fractures, Bone/complications* ; Humans ; Hypoalbuminemia/complications* ; Incidence ; Osteoporosis/complications* ; Prevalence ; Retrospective Studies ; Risk Factors ; Spinal Fractures/surgery* ; Venous Thromboembolism