Comparative outcomes of medial and lateral plating for distal third tibial fractures: A systematic review and meta-analysis

Background: Distal third tibial fractures pose significant surgical challenges due to minimal soft-tissue coverage and a high risk of wound complications. Although both medial and lateral plating techniques are commonly used for fixation, the best surgical approach remains debated. This systematic review and meta-analysis aimed to compare the clinical outcomes and complication rates of medial and lateral plating for distal third tibial fractures. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Embase from inception to June 2025 in accordance with PRISMA guidelines. Comparative studies involving adult patients with distal third tibial fractures treated with either medial or lateral plating were included. Risk of bias was assessed using standardized tools. Quantitative synthesis was performed when comparable outcomes were reported in at least two studies. Pooled effect estimates were calculated as odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs). Results: 15 studies comprising 707 patients met the inclusion criteria. Meta-analysis demonstrated that medial plating was associated with significantly higher rates of hardware-related complications (OR 4.17; 95% CI 2.67-6.49), implant removal (OR 5.97; 95% CI 2.11-16.87), postoperative infection (RR 1.98; 95% CI 1.26-3.12), and overall soft-tissue complications (OR 3.25; 95% CI 1.84-5.75) compared with lateral plating. Wound dehiscence occurred less frequently with lateral plating (OR 0.24; 95% CI 0.13-0.45). No significant difference was observed between the two approaches in terms of malunion rates. Conclusion: The findings suggest that lateral plating may be associated with lower soft-tissue morbidity but comparable fracture alignment with medial plating. Since most included studies were observational and relatively small, the findings should be considered hypothesis-generating rather than definitive. Treatment decisions should therefore remain individualized. Further well-designed randomized controlled trials (RCT)s are needed to confirm these findings.