Should Insertion of Intramedullary Nails for Tibial Fractures Be With or Without Reaming?

Larsen, Leif Børge; Madsen, Jan Erik; Høiness, Per Reidar; Øvre, Stein

doi:10.1097/00005131-200403000-00003

Cited by 141 publications

(110 citation statements)

References 29 publications

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“…Another six articles were excluded (Appendix 1. Supplemental materials are available with the online version of CORR 1 ), leaving 14 eligible studies [2,12,13,19,22,25,27,30,39,[41][42][43][44][45] for our survey. The weighted kappa for full-text article eligibility was good (j = 0.79; 95% CI, 0.46-0.98).…”

Section: Literature Searchmentioning

confidence: 99%

“…Eight of the studies were randomized [2,13,25,27,30,41,42,45] and six were quasirandomized controlled trials [12,19,22,39,43,44]. Five studies included patients with open and closed fractures [13,27,41,42,45]; however, we extracted and included data only from the subset of patients with open fractures in these trials. In Fig.…”

Section: Literature Searchmentioning

confidence: 99%

“…One trial was at low risk of bias [42], three studies were at moderate risk [25,27,45], and the remainder were high risk [2,12,13,19,22,30,39,41,43,44]. Four trials concealed allocation [25,27,42,45], but only one trial blinded outcome assessors [42].…”

Section: Literature Searchmentioning

confidence: 99%

“…Four trials concealed allocation [25,27,42,45], but only one trial blinded outcome assessors [42]. The Cochrane risk of bias plot shows the assessments conducted for each study included in our review (Fig.…”

Section: Literature Searchmentioning

confidence: 99%

“…Previous reviews have focused on intramedullary nailing and have been based on a small number of trials [3,4]. There has been a resurgence of randomized trials evaluating different treatment modalities for open fractures, including comparisons of reamed with unreamed intramedullary nailing [27,40,42]; intramedullary nailing with ender nailing [41]; intramedullary nailing with external fixation [30,39]; external fixation (AO) with the Ilizarov technique [12]; and plate osteosynthesis with intramedullary nailing [45].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

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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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Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Intramedullary nailing for tibial shaft fractures in adults

Duan

Al-Qwbani

Zeng

et al. 2012

Cochrane Database of Systematic Reviews

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BackgroundIntramedullary nailing is commonly used for treating fractures of the tibial shaft. These fractures are one of the most common long bone fractures in adults. ObjectivesTo assess the effects (benefits and harms) of different methods and types of intramedullary nailing for treating tibial shaft fractures in adults. Search methodsWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and reference lists of articles to December 2009. The search was subsequently updated to September 2011 to assess the more recent literature. Selection criteriaRandomised and quasi-randomised controlled clinical studies evaluating different methods and types of intramedullary nailing for treating tibial shaft fractures in adults were included. Primary outcomes were health-related quality of life, patient-reported function and re-operation for treatment failure or complications. Data collection and analysisAt least two review authors independently performed study selection, risk of bias assessment, and data collection and extraction. Main resultsNine randomised and two quasi-randomised clinical trials, involving a total of 2093 participants with 2123 fractures, were included. The evidence was dominated by one large multicentre trial of 1319 participants. Both quasi-randomised trials were at high risk of selection bias. Otherwise, the trials were generally at low or unclear risk of bias. There were very few data on functional outcomes; and often incomplete data on re-operations. The trials evaluated five different comparisons of interventions: reamed versus unreamed intramedullary nailing (six trials); Ender nail versus interlocking nail (two trials); expandable nail versus interlocking nail (one trial);

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Tibial Shaft Fractures

Yong

Molloy

Gitajn

2021

Evidence‐Based Orthopedics

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Should Insertion of Intramedullary Nails for Tibial Fractures Be With or Without Reaming?

Abstract: Unreamed nailing in patients with tibial shaft fractures may be associated with higher rates of secondary operations and malunions compared with reamed nailing. The time to fracture healing was significantly longer with unreamed nails.

Cited by 141 publications

References 29 publications

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

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

Intramedullary nailing for tibial shaft fractures in adults

Tibial Shaft Fractures

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