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26-07-2023 | Tibia Fracture | Original Paper

External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials

Authors: Jawaher F. Alsharef, Abdullah A. Ghaddaf, Mohammed S. AlQuhaibi, Esraa A. Shaheen, Lamar H. AboAljadiel, Abdullah S. Alharbi, Bashair Y. AlHidri, Mohammed K. Alamri, Asim M. Makhdom

Published in: International Orthopaedics | Issue 12/2023

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Abstract

Aim

Tibial shaft fractures are the most common type of long-bone fractures. External fixation (EF) and intramedullary nailing (IMN) are widely used surgical techniques for the definitive fixation of open tibial shaft fractures. The aim of this systematic review and meta-analysis was to compare EF to IMN for the definitive fixation of open tibial fractures.

Methods

Medline, Embase, and CENTRAL databases were searched for eligible studies. We included randomized controlled trials (RCTs) that compared EF to IMN for skeletally mature adults with open tibial fracture (Gustilo I, II, and III). We evaluated the following outcomes: superficial infection, pin-track infection, deep infection, malunion, nonunion, delayed union, and implant/hardware failure. The risk ratio (RR) was used to represent the desired outcomes. The statistical analysis was performed using the random-effects model.

Results

A total of 12 RCTs that enrolled 1090 participants were deemed eligible for the analysis. EF showed a significantly higher rate of superficial infection, pin track infection, and malunion compared to IMN (RR = 2.30, 95% confidence interval (CI): 1.34 to 3.95; RR = 13.52, 95% CI: 6.16 to 29.66; RR = 2.29, 95% CI 1.41 to 3.73, respectively). No substantial difference was found between EF and IMN in terms of deep infection, nonunion, delayed union, or implant/hardware failure (RR = 1.15, 95% CI 0.67 to 1.98; RR = 0.92, 95% CI 0.77 to 1.10; RR = 1.50, 95% CI 0.98 to 3.33; RR = 0.96, 95% CI 0.36 to 2.60, respectively).

Discussion

The findings of our meta-analysis are consistent with the previous systematic reviews excepts for the implant/hardware failure which was found to be significant in favour of IMN by one of the previous reviews.

Conclusion

This meta-analysis confirms that IMN is better than EF with respect to clinical outcomes and complication rate for the definitive fixation of open tibial fracture.
Appendix
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Metadata
Title
External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials
Authors
Jawaher F. Alsharef
Abdullah A. Ghaddaf
Mohammed S. AlQuhaibi
Esraa A. Shaheen
Lamar H. AboAljadiel
Abdullah S. Alharbi
Bashair Y. AlHidri
Mohammed K. Alamri
Asim M. Makhdom
Publication date
26-07-2023
Publisher
Springer Berlin Heidelberg
Keyword
Tibia Fracture
Published in
International Orthopaedics / Issue 12/2023
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-023-05879-7

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