Abstract
Controversy exists over whether the use of external fixation (EF) or unreamed tibial intramedullary nailing (UTN) is optimal for the treatment of open tibial fractures. The aim of this study was to compare clinical outcomes in terms of postoperative superficial and deep infection, malunion, delayed union, nonunion and hardware failure between these two treatment methods. So a systematic review and meta-analysis was performed. All available randomized controlled trials that compared the clinical results of EF to those of UTN were obtained and the reported numbers of citations for each observed item were extracted to perform data synthesis. Six published randomized controlled trials with a total of 407 cases fulfilled all inclusion criteria. Data analysis revealed that UTN reduced the incidence rates of superficial infection and malunion after fixation compared with EF. However, EF led to a significant reduction in hardware failure. For postoperative deep infection, delayed union and nonunion, the treatment effects were similar between these two groups. Therefore, we recommend UTN over EF for the management of open tibial fractures. However, patients’ postoperative weight bearing should be controlled to avoid hardware failure.
Highlights
Before the introduction of intramedullary nailing, the most widely accepted surgical treatment for open tibial fractures was external fixation (EF)
An English language literature search of PubMed, Cochrane Library, EMBASE, BIOSIS, Ovid and the Cochrane Central Register of Controlled Trials (1980 to July 2018) was performed with the following Medical Subject Heading (MeSH) terms used in different combinations: open tibial fractures, external fixation, unreamed tibial intramedullary nailing, treatment outcome, and comparative study
Analysis revealed a significant difference in the pooled treatment effect favoring unreamed tibial intramedullary nailing (UTN), with no heterogeneity (RR = 5.13; 95% confidence intervals (CIs): 2.56 to 10.28; P < 0.00001; I2 = 0%; Fig. 2)
Summary
Before the introduction of intramedullary nailing, the most widely accepted surgical treatment for open tibial fractures was EF This technique gained widespread popularity because of its fast and easy application without additional blood supply irritation or soft tissue stripping. Xu et al.[17] conducted meta-analysis of randomized clinical trials (RCTs) of the use of external fixators versus intramedullary nails to treat open tibial fracture. These authors suggested that intramedullary nails are more effective than external fixators. We aimed to perform a scientific evaluation of all available literature to increase the current understanding of the management of this trauma
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