Unreamed Intramedullary Nailing is a Better Alternative than External Fixator for Gustilo Grade IIIB Tibial Fractures Based on a Meta-Analysis

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Abstract
Background and Aims: There remains a controversy between unreamed intramedullary nailing and external fixation to treat Gustilo grade IIIB tibial fractures. To evaluate the comparative effectiveness and safeness of both methods for this type of fracture, we performed this meta-analysis. Materials and Methods: Relevant original studies were searched in MEDLINE, EMBASE, China National Knowledge Infrastructure, and Cochrane Central Database (all through February 2014). Studies included in this meta-analysis had to compare the effectiveness or complications and provided sufficient data of interest. The patients treated by both methods were similar statistically in demography and injury mechanism. The Stata 11.0 was used to analyze all data. Results: Six studies involving 163 participants were included. Unreamed intramedullary nailing was associated with reduced time to union (standardized mean difference, −1.14; 95% confidence interval, −2.04 to −0.24) and lower rates of superficial infection (odds ratio: 0.39; 95% confidence interval: 0.17–0.87) and malunion (odds ratio: 0.27; 95% confidence interval: 0.09–0.78). However, there were no significant differences in other adverse events including delayed union, non-union, deep infection, and fixation failure. Conclusion: The existing evidence supports unreamed intramedullary nailing to be a better method for treating Gustilo grade IIIB tibial fractures, and this might aid in the management of this sever injury.

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