A Prospective, Randomized Study of Intramedullary Nails Inserted With and Without Reaming for the Treatment of Open and Closed Fractures of the Tibial Shaft

Finkemeier, Christopher G.; Schmidt, Andrew H.; Kyle, Richard F.; Templeman, David C.; Varecka, Thomas F.

doi:10.1097/00005131-200003000-00007

Cited by 278 publications

(178 citation statements)

References 44 publications

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“…Three of these studies were found in both the PubMed and EMBASE databases [11,31,37]. Twenty-two studies [21,23,24,[31][32][33][34][35]38 [15, 17-19, 22, 25-30, 36, 40, 42, 48] were excluded because they included adults, and we were unable to separate the adult data from those of patients \18 years of age. Three papers [29,37,43] were excluded because they were review papers and not studies that included patient treatment and follow-up information.…”

Section: Methodsmentioning

confidence: 99%

Open fractures of the tibia in the pediatric population: A systematic review

Baldwin

Babatunde

Huffman

et al. 2009

Journal of Children's Orthopaedics

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PurposeThe management of open fractures of the tibia in a pediatric population represents a challenge to the clinician. Several case series over the course of many years have been performed describing the results of treating these injuries. It remains unclear, however, whether there is a preferred modality of treatment for these injuries, if a more severe injury confers a greater risk of infection, and if time to union is affected by Gustilo type, although trends seem to exist. The purpose of this study was to assemble the available data to determine (1) the risk of infection and time to union of various subtypes of open tibia fractures in children and (2) the changes in treatment pattern over the past three decades. Methods A systematic review of the available literature was performed. Frequency weighted mean union times were used to compare union times for different types of open fractures. Mantel Haentzel cumulative odds ratios were used to compare infection risk between different types of open fractures. Linear regression by year was used to determine treatment practices over time.Results No significant change in practice patterns was found for type I and III fractures, although type II fractures were more likely to be treated closed in the later years of the study compared to the earlier years. Type III fractures conferred a 3.5-and 2.3-fold greater odds of infection than type I and type II fractures, respectively. There was no significant difference in odds of infection between type I and II fractures. There was a significant delay in mean time to union between type I and type II fractures, and between type II and type III fractures. Conclusions With the exception of type II fractures, the philosophy of treatment of open fractures of the tibia has not significantly changed over the past three decades. Closed treatment or internal fixation are both viable options for type II fractures based on their relatively low incidence of infection. This study also demonstrates a strong relationship between Gustillo sub-types and odds of infection in this population. Not surprisingly, union rates are also delayed with increasing injury severity.

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Section: Methodsmentioning

confidence: 99%

Open fractures of the tibia in the pediatric population: A systematic review

Baldwin

Babatunde

Huffman

et al. 2009

Journal of Children's Orthopaedics

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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%

“…2 & 4). Four trials compared unreamed with reamed nailing (n = 547) as a management technique [13,25,27,42] and five compared unreamed nailing with external fixation (n = 402) [19,30,39,43,44]. The five remaining trials [2,12,22,41,45] compared (1) unreamed intramedullary nailing with Ender nailing (n = 75); (2) external fixation with Ender nailing (n = 57); (3) plate with external fixation (n = 56); (4) Ilizarov with AO external fixation (n = 120); and (5) reamed nailing with plate fixation (n = 40) for treatment of patients with tibial fractures.…”

Section: Literature Searchmentioning

confidence: 99%

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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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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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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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A Prospective, Randomized Study of Intramedullary Nails Inserted With and Without Reaming for the Treatment of Open and Closed Fractures of the Tibial Shaft

Abstract: Our findings support the use of reamed insertion of IM nails for the treatment of closed tibia fractures, which led to earlier time to union without increased complications. In addition, canal reaming did not increase the risk of complications in open tibia fractures.

Cited by 278 publications

References 44 publications

Open fractures of the tibia in the pediatric population: A systematic review

Open fractures of the tibia in the pediatric population: A systematic review

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

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