Treatment of open fractures of the shaft of the tibia - A systematic overview and meta-analysis

We have systematically reviewed the effect of alternative methods of stabil isation of open tibial fractures on the rates of reoperation, and the secon dary outcomes of nonunion, deep and superficial infection, failure of the i mplant and malunion by the analysis of 799 citations on the subject, identi fied from computerised databases. Although 68 proved to be potentially elig ible, only eight met all criteria for inclusion. Three investigators indepe ndently graded the quality of each study and extracted the relevant data. One study (n = 56 patients) suggested that the use of external fixators sig nificantly decreased the requirement for reoperation when compared with fix ation with plates. The use of unreamed nails, compared with external fixato rs (five studies, n = 396 patients), reduced the risk of reoperation, malun ion and superficial infection. Comparison of reamed with unreamed nails showed a reduced risk of reoperati on (two studies, n = 132) with the reamed technique. An indirect comparison between reamed nails and external fixators also showed a reduced risk of r eoperation (two studies) when using nails. We have identified compelling evidence that unreamed nails reduced the inci dence of reoperations, superficial infections and malunions, when compared with external fixators. The relative merits of reamed versus unreamed nails in the treatment of open tibial fractures remain uncertain.