Interlocking Intramedullary Nailing Versus Unilateral External Fixation For Open Tibial Shaft Fractures: A Systematic Review

[Objective]:To determine the effect of Interlocking Intramedullary nailing versus Unilateral external fixation for open tibial shaft fractures.[Method]:MEDLINE (1966-March, December-2010), OVID(1974-March, December-2010), Pubmed (1990, December-2010), The Cochrane Library and CBMdisc (1990-December, December-2010), CNKIdisc (1990-December-2010), and the relevant Chinese and English orthopedic journals were searched retrospectively. Randomized controlled trials (RCTs) and Controlled Clinical Trials (CCTs) of Interlocking Intramedullary nailing versus Unilateral external fixation for grade open tibial shaft fractures were included. The system review was performed using the method recommended by the Cochrane Collaboration.[Result]:Four studies (2 RCTs and 7 CCTs) were included, involving 861 patients. The results of meta-analysis showed there were no significant differences in the rate of nonunion and delayed union between group Interlocking Intramedullary nailing and Unilateral external fixation. The rate of malunion in group Interlocking Intramedullary nailing was lower than that in group Unilateral external fixation, while the rate of implant failure was higher than the latter. In gradeâ…¢A open tibial fractures, the incidence of superficial infection in group Interlocking Intramedullary nailing was significantly lower than that in group Unilateral external fixation, but there was no difference in deep infection between both groups. However, the infective rate of the two groups had no significant difference in gradeâ…¢B open fractures.[Conclusion]:Compared with Unilateral external fixation, the Interlocking Intramedullary tibial nailing had a decreased incidence of maluinon and superficial infection in gradeâ…¢A open tibial fractures. However, more high quality, large-scale randomized controlled trials are required for accurate conclusion.