Non-reamed Versus Reamed Intramedullary Nailing For Tibial Fractures In Adult: A Systematic Review

Objective: To determine the effect of non-reamed versus reamed intramedullary nailing for tibial fractures in adult on the rates of nonunion, the rates of implant failure, the rates of infection, the incidence of compartment syndrome, the rates of malunion and the time of union. Methods:We searched MEDLINE (1966-July, 2005), EMBASE (1966-July, 2005), The Cochrane Library (Issue 2, 2005), CBMdisc (1979-July, 2005); and handsearched the relevant Chinese and English orthopedic journals. RCTs and CCTs of non-reamed versus reamed intramedullary nailing for tibial fractures in adult were included, The quality of trials was critically assessed. RevMan 4.2.7 software was used for data analysis. Results: Four RCTs and one CCTs of non-reamed versus reamed intramedullary nailing for tibial fractures in adult were included, The results of meta-analysis showed that non-reamed intramedullary nailing for tibial fractures in adult increase the rates of nonunion (RR 1.87, 95%CI 1.20 to 2.91, P=0.006), implant failure (RR 2.23, 95%CI 1.49 to 3.34, P<0.0001) and the time to union (WMD 9.00, 95%CI 3.19 to 14.81, P=0.002). Conclusion: Compared with reamed intramedullary nailing for tibial fractures in adults, non-reamed intramedullary nailing increase the rates of nonunion and implant failure was common, There were no statistical difference in the rates of infection and the rates of infection and the incidence of compartment syndrome in both group. However, the effect of reamed or not to these outcomes need...