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

Abstract

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.

Prevalence and influencing factors of nonunion in patients with tibial fracture: systematic review and meta-analysis

“…The nonunion rate of conservative treatment was the highest one compared with that of surgical treatment. This is obviously different from the lowest rate reported by Li H et al [148]. This may be related to the insufficient number of articles in conservative treatment.…”

“…3 The publication bias of prevalence of tibia fracture nonunion reduction than "simple" type A fractures. So it is unreasonable to only consider the nonunion rate of fracture of operation [148].…”

“…For example, in distal tibial fractures, more comminuted fractures would rather require open reduction than “simple” type A fractures. So it is unreasonable to only consider the nonunion rate of fracture of operation [ 148 ].…”

Treatment of open and comminuted mid-distal tibial fractures by bilateral external fixation combined with limited-internal fixation

“…The X-ray images of two typical cases before and after the surgery are shown in Figure 1 and 2. Intramedullary nailing, plate osteosynthesis, and external fixation are the most common fixation methods with their own advantages and indications (10,11). It is…”

Union in Fracture Tibia Managed with Closed Intramedullary Interlocking Nail, Our Hospital Results

“…Tibial shaft fractures occur in about 2/1000 people per year in the general population [1]. It has been found that nonoperative treatment of high-energy-induced displaced tibial shaft fractures is linked with a significant risk of malunion, joint stiffness, and a subpar long-term functional outcome [2,3]. To treat closed displaced tibial shaft fractures, intramedullary fixation devices such as Centro medullary nails (K nails and V nails), interlocking intramedullary nails (reamed or unreamed), and numerous flexible intramedullary pins, such as Ender nails, have been utilized [4].…”