SKELETAL FIXATION OF GRADE IIIB TIBIAL FRACTURES - THE POTENTIAL OF METAANALYSIS

Contemporary management of Grade IIIB open tibial fractures has evolve d to include intravenous antibiotics, thorough interval surgical debri dement, rigid skeletal fixation, early local or free tissue myoplasty, and liberal use of autogenous bone graft beneath a clean, stable woun d. External fixation has been the skeletal stabilization of choice wit h the lowest reported deep sepsis fates, Pin tract infection, malunion , and nonunion have complicated its use, Static unreamed locked nailin g is an alternative treatment that has been successfully used in lower grade open tibial fractures. A metaanalysis of the literature was und ertaken to determine whether there was evidence favoring 1 method of s keletal fixation. Inclusion criteria were restricted to studies that m ere randomized to either external fixation or unreamed intramedullary nail methods and that used a strict definition of Grade IIIB to includ e muscle transfer for soft tissue coverage. Two studies were identifie d and combined to show no difference in deep sepsis rate, Intramedulla ry nailing significantly shortened union time whereas external fixatio n showed a trend toward a higher incidence of malunion and superficial sepsis, More well designed randomized studies would add to this initi al effort and yield more compelling evidence for either form of fixati on.