Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials

Xue, Deting; Zheng, Qiang; Li, Hang; Qian, Shengjun; Zhang, Bo; Pan, Zhijun

doi:10.1007/s00264-009-0895-x

Cited by 33 publications

(26 citation statements)

References 25 publications

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“…Our conclusions are in accordance with previous studies [20][21][22][23] . Forster et al 21 report that reamed intramedullary nailing is better than nonreamed in union rate, but no significant difference is observed in the incidence of complications except screw breakage.…”

Section: Discussionsupporting

confidence: 94%

System evaluation on reamed and non-reamed intramedullary nailing in the treatment of closed tibial fracture

Zhao

et al. 2013

Acta Cir. Bras.

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Section: Discussionsupporting

confidence: 94%

System evaluation on reamed and non-reamed intramedullary nailing in the treatment of closed tibial fracture

Zhao

et al. 2013

Acta Cir. Bras.

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“…Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risk for nonunion, screw failure, implant exchange, and dynamization without increasing operative complications [21,25], whereas the choice for open tibial fractures remains uncertain [26].…”

Section: Discussionmentioning

confidence: 99%

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Hierholzer

Friederichs

Glowalla

et al. 2016

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome. Methods This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term followup was analyzed for rate of bone healing and functional outcome. Results Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result. Discussion Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.

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“…There have been numerous systematic reviews using traditional head-to-head meta-analyses for tibial shaft fracture management [3,4,7,11,26,31,47]. Of these, only one evaluated [3] an intervention other than reamed or unreamed nailing.…”

Section: Key Findingsmentioning

confidence: 99%

Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

Foote

Guyatt

Vignesh

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Open tibial shaft fractures are one of the most devastating orthopaedic injuries. Surgical treatment options include reamed or unreamed nailing, plating, Ender nails, Ilizarov fixation, and external fixation. Using a network meta-analysis allows comparison and facilitates pooling of a diverse population of randomized trials across these approaches in ways that a traditional meta-analysis does not. Questions/purposes Our aim was to perform a network meta-analysis using evidence from randomized trials on the relative effect of alternative approaches on the risk of unplanned reoperation after open fractures of the tibial diaphysis. Our secondary study endpoints included malunion, deep infection, and superficial infection. Methods A network meta-analysis allows for simultaneous consideration of the relative effectiveness of multiple treatment alternatives. To do this on the subject of surgical treatments for open tibial fractures, we began with systematic searches of databases (including EMBASE and MEDLINE) and performed hand searches of orthopaedic journals, bibliographies, abstracts from orthopaedic conferences, and orthopaedic textbooks, for all relevant material published between 1980 and 2013. Two authors independently screened abstracts and manuscripts and extracted the data, three evaluated the risk of bias in individual studies, and two applied Grading of Recommendation Assessment, Development and Evaluation (GRADE) criteria to bodies of evidence. We included all randomized and quasirandomized trials comparing two (or more) surgical treatment options for open tibial shaft fractures in predominantly (ie, [ 80%) adult patients. We calculated pooled estimates for all direct comparisons and conducted a network meta-analysis combining direct and indirect evidence for all 15 comparisons between six stabilization strategies. Fourteen trials published between Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. This study was performed at

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Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials

Cited by 33 publications

References 25 publications

System evaluation on reamed and non-reamed intramedullary nailing in the treatment of closed tibial fracture

System evaluation on reamed and non-reamed intramedullary nailing in the treatment of closed tibial fracture

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

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