Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures

Shao, Yinchu; Zou, Hongxing; Chen, Shaobo; Ji-chun, Shan

doi:10.1186/s13018-014-0074-7

Cited by 15 publications

(10 citation statements)

References 18 publications

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“…There is a great discrepancy in infection rate between reamed and unreamed IM nailing when reviewing literature. A recent meta-analysis with the aim of comparing the outcome of these two procedures showed no difference in union rate, secondary surgery rate, implant failure rate, osteofascial compartment syndrome, and infection during the postoperative period (16). Similar to our findings, the risk of infection was similar in both types of procedures (relative risk of 1.03) with an acceptable homogeneity across the analyzed studies.…”

Section: Discussionsupporting

confidence: 88%

Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures

Omrani¹,

Elahi²,

Sarzaeem³

et al. 2020

jost

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Background: Intramedullary nailing (IM nailing) is the standard of care for the treatment of most diaphyseal lower extremity fractures. A few studies have assessed and compared the infection rate following reamed and unreamed IM nailing in open long bone fractures. In the present study, we attempted to compare the infection rate between two procedures in open fractures of tibia. Methods: In this prospective study, we included consecutive patients suffering from open fractures of tibia (Gustilo subtypes II or IIIA) who required IM nailing. Patients younger than 16 years old, other Gustilo types (I, IIIB, and IIIC), fractures reaching to the tibial plateau articular surface, and simultaneous fractures of other bones in the extremity were excluded. All patients were followed up for one year to assess the postoperative infection rate. Results: Of 59 patients, 37 underwent reamed IM nailing and 22 underwent unreamed IM nailing. In reamed group, 4 cases (10.8%) experienced an infection requiring reoperation and antibiotic therapy, while in the unreamed group, it was 5 cases (22.7%). The difference between the groups was not statistically significant. Conclusion: Reamed and unreamed IM nailing procedures for fractures of tibia have similar outcome regarding long-term postoperative infections that require reoperation and antibiotic therapy.

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Section: Discussionsupporting

confidence: 88%

Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures

Omrani¹,

Elahi²,

Sarzaeem³

et al. 2020

jost

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“…C remained the best treatment for closed cases in the case of three indices with supportive data. Considering the high risk of bias of trials in included Foote's NMA, and the outcome of some traditional meta-analyses that there was no significant difference between RIN and UIN for open cases, and RIN was recommended by more for closed fractures, we contend our conclusion that the type of fracture was not distinguished (Xue et al, 2010; Li et al, 2013; Shao et al, 2014; Xia et al, 2014; Yu et al, 2014).…”

Section: Discussionmentioning

confidence: 87%

Multiple Comparisons of the Efficacy and Safety for Seven Treatments in Tibia Shaft Fracture Patients

Yu²,

et al. 2019

Front. Pharmacol.

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Background: A tibia shaft fracture is one of the most common long bone fractures, with two general types, open fracture and close fracture. However, there is no universally accepted guideline suggesting which treatment to use under certain circumstances. Therefore, a comprehensive network meta-analysis (NMA) is needed to summarize existing studies and to provide more credible data-based medical guidelines. Methods: Available literature was identified by searching medical databases with relevant key terms. Studies that met the inclusion and exclusion criteria, baseline, intervention, and the outcome of treatments, were extracted. A comparative connection of these studies was demonstrated through net plots. Continuous variables and binary variables were reported as mean difference (MD) and odds ratio (OR) with a 95% credible interval (CrI), respectively. The comparison of direct and indirect outcome and their P -value were listed in the node-splitting table. Treatments for each endpoint were ranked by their surface under the cumulative ranking curve (SUCRA) value. A heat plot was created to illustrate the contribution of raw data and the inconsistency between direct and indirect comparisons. Results: According to the search strategy, 697 publications were identified, and 25 records were included, involving 3,032 patients with tibia shaft fractures. Seven common surgical or non-surgical treatments, including reamed intramedullary nailing (RIN), un-reamed intramedullary nailing (UIN), minimally reamed intramedullary nailing (MIN), ender nailing (EN), external fixation (EF), plate, and cast, were compared, in terms of time to union, reoperation, non-union, malunion, infection and implant failure. Plate performed relatively better for time to union, while cast might be the best choice in close cases to reduce the risks of reoperation, non-union, malunion, and infection. To prevent implant failure, EN seemed to be better. Conclusion: Cast might have the highest probability of the most optimal choice for tibia shaft fracture in close cases, while reamed intramedullary nailing ranked second.

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“… 53 It has been suggested that reaming allows for the insertion of larger diameter nails and increases stability. 38 , 54 , 55 This may be achieved, however, at the cost of damaging endosteal blood supply and diminishing cortical wall thickness. 56 , 57 Unreamed nailing shows comparable outcomes to reamed nails in terms of infection rates, 38 , 45 , 56 risk of nonunion and rates of re-operation.…”

Section: Principles Of Managementmentioning

confidence: 99%

Open fractures of the lower extremity

2018

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Open fractures of the lower extremity are the most common open long bone injuries, yet their management remains a topic of debate.This article discusses the basic tenets of management and the subsequent impact on clinical outcome. These include the rationale for initial debridement, antimicrobial cover, addressing the soft-tissue injury and definitive skeletal management.The classification of injury severity continues to be a useful tool in guiding treatment and predicting outcome and prognosis. The Gustilo-Anderson classification continues to be the mainstay, but the adoption of severity scores such as the Ganga Hospital score may provide additional predictive utility.Recent literature has challenged the perceived need for rapid debridement within 6 hours and the rationale for prolonged antibiotic therapy in the open fracture. The choice of definitive treatment must be decided against known efficacy and injury severity/type.Recent data demonstrate better outcomes with internal fixation methods in most open tibial fractures, but external fixation continues to be an appropriate choice in more severe injuries. The incidence of infection and non-union has decreased with new treatment approaches but continues to be a source of significant morbidity and mortality.Assessment of functional outcome using various measures has been prevalent in the literature, but there is limited consensus regarding the best measures to be used.Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170072

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Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures

Cited by 15 publications

References 18 publications

Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures

Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures

Multiple Comparisons of the Efficacy and Safety for Seven Treatments in Tibia Shaft Fracture Patients

Open fractures of the lower extremity

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