Meta Analysis Of Reamed Versus Nonreamed Intramedullary Nailing For Closed Tibial Fractures In Adults

[Objective] According to Cochrane Meta analysis, determine the efficiency and safety of reamed VS unreamed intramedullary nailing for closed tibial Fractures in adults on the rates of malunions,nonunion, delay union, the rates of implant failure, the rates of compartment syndrome, infections, the time of union, etal.[Methods] We searched Pubmed (1966-2012.03), EMBASE(1974-2012.03), SC1(1979-2012.03), The Cochranel Library (issue3,2012) and,CBMdisc(1979-2012.03), VIPinformationO989-2012.03), WANG FANG DATA(1982-2011.03), CNKI(1966-2012.03),and artificial-seached the suitable home and abroad orthopedic journals. There were were included of randomized controlled trials and Chnical controled tails of reamed VS unreamed--intramedulary nailing for closed tibial fractures in adults. The qualities were critically assessed. It was used of RevMan5.0for data analysis. The odds radio (OR) and relative risk (RR) were determined. All the works were expressed by95%confidence intervals (CI). The rates of nonunion, delay union, malunions,the rates of implant failure,the rates of compartment syndrome, infections and the time of union, et al were met the evaluation criterion.[Results] Three RCTs were included by total retrieve and riddling with total of263patients met the evaluation criterion. For methodology quality of literatures, one was A, one was B, and one was C. The corresponding results were showed that the reamed method for closed tibial fractures in adults reduce the rates of nonunion [RR0.25,95%CI(0.08,0.79), P=0.02], implant failure [RR0.25,95%CI(0.12,0.52) P=0.0002].there are no significant difference in rates of delay union[RR0.55,95%CI(0.21,1.44)], rates of malunions[RR0.54,95%CI(0.19,1.53)] and compartment syndrome[RR0.53,95%CI(0.12,2.32)].[Conclusion] with unreamed intramedulary nailing for closed tibial fractures in adults, reamed intramedulary nailing reduce the rates of implant failure and nonunion.There were no diferences in the complications of malunions, compartment syndrome and delayunion,et al. However,further studies should reseach of the rare complication of the fat embolism syndrome and Pulmonary embolism,et al between reamed and nonreamed intramedulary nailing for closed tibial Fractures in adults.