Treatment of Type II, IIIA, and IIIB Open Fractures of the Tibial Shaft: A Prospective Comparison of Unreamed Interlocking Intramedullary Nails and Half-Pin External Fixators

Henley, M. Bradford; Chapman, Jens R.; Agel, Julie; Harvey, Edward J.; Whorton, A. M.; Swiontkowski, Marc F.

doi:10.1097/00005131-199801000-00001

Cited by 239 publications

(186 citation statements)

References 18 publications

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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.…”

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

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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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Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

See 2 more Smart Citations

Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

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Guyatt

Vignesh

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…The question was whether use of negative pressure wound therapy beyond 72 hours would result in increased infection rates compared with historic controls [1,11,13,20,26,28]. Reported infection rates are highly variable for Grade IIIB tibia wounds with the upper end at 67% [10].…”

Section: Does Negative Pressure Wound Therapy Facilitate Late Flap Prmentioning

confidence: 99%

Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures?

Schlatterer

Hirschfeld

Webb

2015

Clinical Orthopaedics &Amp; Related Research

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Background Grade IIIB open tibia fractures are devastating injuries. Some clinicians advocate wound closure or stable muscle flap coverage within 72 hours to limit complications such as infection. Negative pressure wound therapy was approved by the FDA in 1997 and has become an adjunct for many surgeons in treating these fractures. Opinions vary regarding the extent to which negative pressure wound therapy contributes to limb salvage. Evidence-based practice guidelines are limited for use of negative pressure wound therapy in Grade IIIB tibia fractures. This systematic literature review of negative pressure wound therapy in Grade IIIB tibia fractures may substantiate current use and guide future studies. Questions/purposes We sought to answer the following:(1) Does the use of negative pressure would therapy compared with gauze dressings lead to fewer infections? (2) Does it allow flap procedures to be performed safely beyond 72 hours without increased infection rates? (3) Is it associated with fewer local or free flap procedures? Methods We conducted a systematic review of six large databases (through September 1, 2013) for studies reporting use of negative pressure wound therapy in Grade IIIB open tibia fractures, including information regarding infection rates and soft tissue reconstruction. The systematic review identified one randomized controlled trial and 12 retrospective studies: four studies compared infection rates between negative pressure wound therapy and gauze dressings, 10 addressed infection rates with extended use, and six reported on flap coverage rates in relation to negative pressure wound therapy use beyond 72 hours. None of the 13 studies was eliminated owing to lack of study quality.

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Tibial Shaft Fractures

Yong

Molloy

Gitajn

2021

Evidence‐Based Orthopedics

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Treatment of Type II, IIIA, and IIIB Open Fractures of the Tibial Shaft: A Prospective Comparison of Unreamed Interlocking Intramedullary Nails and Half-Pin External Fixators

Cited by 239 publications

References 18 publications

Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures?

Tibial Shaft Fractures

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