Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials |
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Authors: | Deting Xue Qiang Zheng Hang Li Shengjun Qian Bo Zhang Zhijun Pan |
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Institution: | (1) Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, 310009 Hangzhou, People’s Republic of China; |
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Abstract: | The choice between reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures is an
ongoing controversy. We carried out a comprehensive search strategy. Six eligible randomised controlled trials were included.
Three reviewers independently assessed methodological quality and extracted outcome data. Analyses were performed using Review
Manager 5.0. The results showed lower risks of tibial fracture nonunion and implant failures with reamed nails compared to
unreamed nails in closed tibial fractures relative risk (RR): 0.41, 95% confidence interval (CI): 0.21–0.89, P = 0.008 for nonunion and RR: 0.35, 95% CI: 0.22–0.56, P < 0.0001 for implant failures], but no statistical differences in risk reduction of malunion, compartment syndrome, embolism
and infection. Our results suggested no statistical differences in risk reduction of all the complications evaluated between
reamed and unreamed nails in open tibial fractures. In conclusion, our study recommended reamed nails for the treatment of
closed tibial fractures. But the choice for open tibial fractures remains uncertain. |
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