Unreamed Interlocking Nail versus External Fixator for Open Type III Tibia Fractures

Abstract

We undertook a prospective study comparing the unreamed interlocking nail to Hoffmann external skeletal fixation (ESF) in the treatment of 36 consecutive patients with open type IIIA and IIIB tibia fractures. The choice of interlocking nail or Hoffmann ESF was randomized, ultimately producing four different patient groups: group 1, type IIIA fractures treated by interlocking nail; group 2, type IIIA fractures treated by ESF; group 3, type IIIB fractures with interlocking nail; and group 4, type IIIB fractures with ESF. The average length of follow-up was 20.5 months. The infection rate was highest in group 3 (3 of 8). The malrotation, malunion, and nonunion rates were highest in group 4 and lowest in group 1. These results suggest the unreamed interlocking nail is a good choice for the treatment of open type IIIA tibia fractures, but not recommended for the treatment of open type IIIB tibia fractures because of the high infection rate.

Comparative Study of the Locked Intramedullary Nail and Ender Pins in the Treatment of Tibial Diaphyseal Fractures

“…These findings are in accordance with the majority of studies related to tibial diaphyseal fractures 1,4,[19][20][21][22][23][24][25][26][27][28] and show the effect of a high level of Only fractures of types A, B, and C2 of the AO group in which both types of fixation-locked intramedullary nail and Ender pins-are considered efficient, were included in this study. 1,5,13,21,[29][30][31][32] We chose to include segmental tibial diaphyseal fractures (C2) based on the work of Merianos et al, 30 who obtained union in all 22 cases treated with Ender pins, with an average union time of only 16 weeks.…”

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

“…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).…”

“…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.…”

“…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].…”

“…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.…”