RETRACTED ARTICLE: A meta-analysis of external fixator versus intramedullary nails for open tibial fracture fixation
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RESEARCH ARTICLE
Open Access
A meta-analysis of external fixator versus intramedullary nails for open tibial fracture fixation Xian Xu†, Xu Li†, Lin Liu and Wei Wu*
Abstract Background: To compare the clinical outcomes of external fixator (EF) and intramedullary nails (IN) in the treatment of open tibial fractures. Methods: We searched seven electronic databases (PubMed, MEDLINE, EMBASE, OVID, Cochrane library, CNKI, and CBM) for trials of tibial fracture fixation published from 1980 to 2013. The indicators including postoperative infection, malunion, nonunion, soft tissue injury, delayed healing, and healing time were used for quantitative outcome assessments. Results: A total of nine trials involving 532 patients (EF, n = 253; IN, n = 279) with open tibia fractures were included in this meta-analysis. The results indicated that the patients undergoing IN had lower incidence of postoperative infection (risk radio [RR] = 3.85; 95% confidence intervals [CI], 2.67–5.54; P < 0.0001), malunion (RR = 2.31; 95% CI, 1.40–3.81; P = 0.001), nonunion (RR = 1.41; 95% CI, 1.06–1.88; P = 0.02) and less healing time (weighted mean difference [WMD] = 6.19; 95% CI, 1.42–10.96; P = 0.01) compared with EF. However, regarding to the soft tissue injury (RR = 0.74; 95% CI, 0.34–1.62; P = 0.45) and delayed healing (RR = 1.38; 95% CI, 0.79–2.43; P = 0.26), there is no significantly difference between EF and IN approach. Conclusion: In conclusion, the use of IN is more effective than EF and may be considered as first-line approach in fixation of open tibial fractures. Keywords: Tibial fractures, Intramedullary nails, External fixator, Meta-analysis
Introduction Open tibial fractures are more frequent than any other long bone fractures, which are showing an increasing trend due to road traffic accidents and firearm injuries [1]. The management of open tibial fractures continues to be a major therapeutic problem because of the poor soft tissue cover and blood supply of the tibial shaft which make these fractures vulnerable to nonunion and infection [2]. Preventing tibia from postoperative infection, obtaining union, and returning the involved limb to normal function always remain elusive goals. External fixator (EF) and intramedullary nailing (IN) are two common approaches for the fixation of open * Correspondence: [email protected] † Equal contributors Department of Traumatic Orthopedics, East Hospital, No.150 Jimo Road, Pudong New District, Shanghai 200120, China
tibial fractures. Initially, the management by EF is well established as it allows immediate stabilization with access for management of the soft tissues [3,4]. However, its use is also associated with significant rates of malunion and pin tract infection often necessitating premature removal and conversion to alternate forms of stabilization [5-7]. In addition, IN approach allows stable fixation with minimal additional violation of the soft tissues in the region of the fracture via placement of unreamed or reamed interlocking nails [8,9]. The use of IN in treating open
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