Cargando…
Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials
BACKGROUND: External fixators (EFs) and intramedullary nailing (IMN) are two effective methods for open tibial fractures. However, both methods have advantages and disadvantages, and the optimal surgical approach remains controversial. Thus, we performed a meta-analysis of randomized controlled tria...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817243/ https://www.ncbi.nlm.nih.gov/pubmed/36604668 http://dx.doi.org/10.1186/s13018-022-03490-x |
_version_ | 1784864713608265728 |
---|---|
author | Liu, Jun Xie, Lifeng Liu, Li Gao, Guicheng Zhou, Ping Chu, Dejun Qiu, Dewei Tao, Jun |
author_facet | Liu, Jun Xie, Lifeng Liu, Li Gao, Guicheng Zhou, Ping Chu, Dejun Qiu, Dewei Tao, Jun |
author_sort | Liu, Jun |
collection | PubMed |
description | BACKGROUND: External fixators (EFs) and intramedullary nailing (IMN) are two effective methods for open tibial fractures. However, both methods have advantages and disadvantages, and the optimal surgical approach remains controversial. Thus, we performed a meta-analysis of randomized controlled trials (RCTs) to compare EF with IMN to evaluate their efficacy and safety. METHODS: A systematic study of the literature was conducted in relevant studies published in PubMed, Embase, the Cochrane Library, Web of Science, CNKI, CBM, Wanfang and Weipu from database inception to April 2022. All eligible literature was critically appraised for methodological quality via the Cochrane's collaboration tool. The primary outcome measurements included postoperative superficial infection, postoperative deep infection, union time, delayed union, malunion, nonunion, and hardware failure. RESULTS: Nine RCTs involving 733 cases were included in the current meta-analysis. The pooled results suggested that cases in the IMN group had a significantly lower postoperative superficial infection rate [risk ratio (RR) = 2.84; 95% confidence interval (CI) = 1.83 to 4.39; P < 0.00001)] and malunion rate (RR = 3.05; 95% CI = 2.06 to 4.52; P < 0.00001) versus EF, but IMN had a significantly higher hardware failure occurrence versus EF (RR = 0.38; 95% CI = 0.17 to 0.83; P = 0.02). There were no significant differences in the postoperative deep infection rate, union time, delayed union rate or nonunion rate between the two groups (p > 0.05). CONCLUSIONS: Compared to EF, IMN had a significantly lower risk of postoperative superficial infection and malunion in patients with open tibial fractures. Meanwhile, IMN did not prolong the union time and increased the risk of the deep infection rate, delayed union rate and nonunion rate but had a higher hardware failure rate. The reanalysis of union time showed that it was significantly shorter in the IMN group than in the EF group after excluding the study with significant heterogeneity during sensitivity analysis. Therefore, IMN is recommended as a preferred method of fracture fixation for patients with open tibial fractures, but more attention should be given to the problem of hardware failure. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13018-022-03490-x. |
format | Online Article Text |
id | pubmed-9817243 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-98172432023-01-07 Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials Liu, Jun Xie, Lifeng Liu, Li Gao, Guicheng Zhou, Ping Chu, Dejun Qiu, Dewei Tao, Jun J Orthop Surg Res Systematic Review BACKGROUND: External fixators (EFs) and intramedullary nailing (IMN) are two effective methods for open tibial fractures. However, both methods have advantages and disadvantages, and the optimal surgical approach remains controversial. Thus, we performed a meta-analysis of randomized controlled trials (RCTs) to compare EF with IMN to evaluate their efficacy and safety. METHODS: A systematic study of the literature was conducted in relevant studies published in PubMed, Embase, the Cochrane Library, Web of Science, CNKI, CBM, Wanfang and Weipu from database inception to April 2022. All eligible literature was critically appraised for methodological quality via the Cochrane's collaboration tool. The primary outcome measurements included postoperative superficial infection, postoperative deep infection, union time, delayed union, malunion, nonunion, and hardware failure. RESULTS: Nine RCTs involving 733 cases were included in the current meta-analysis. The pooled results suggested that cases in the IMN group had a significantly lower postoperative superficial infection rate [risk ratio (RR) = 2.84; 95% confidence interval (CI) = 1.83 to 4.39; P < 0.00001)] and malunion rate (RR = 3.05; 95% CI = 2.06 to 4.52; P < 0.00001) versus EF, but IMN had a significantly higher hardware failure occurrence versus EF (RR = 0.38; 95% CI = 0.17 to 0.83; P = 0.02). There were no significant differences in the postoperative deep infection rate, union time, delayed union rate or nonunion rate between the two groups (p > 0.05). CONCLUSIONS: Compared to EF, IMN had a significantly lower risk of postoperative superficial infection and malunion in patients with open tibial fractures. Meanwhile, IMN did not prolong the union time and increased the risk of the deep infection rate, delayed union rate and nonunion rate but had a higher hardware failure rate. The reanalysis of union time showed that it was significantly shorter in the IMN group than in the EF group after excluding the study with significant heterogeneity during sensitivity analysis. Therefore, IMN is recommended as a preferred method of fracture fixation for patients with open tibial fractures, but more attention should be given to the problem of hardware failure. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13018-022-03490-x. BioMed Central 2023-01-05 /pmc/articles/PMC9817243/ /pubmed/36604668 http://dx.doi.org/10.1186/s13018-022-03490-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Systematic Review Liu, Jun Xie, Lifeng Liu, Li Gao, Guicheng Zhou, Ping Chu, Dejun Qiu, Dewei Tao, Jun Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials |
title | Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials |
title_full | Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials |
title_fullStr | Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials |
title_full_unstemmed | Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials |
title_short | Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials |
title_sort | comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9817243/ https://www.ncbi.nlm.nih.gov/pubmed/36604668 http://dx.doi.org/10.1186/s13018-022-03490-x |
work_keys_str_mv | AT liujun comparingexternalfixatorsandintramedullarynailingfortreatingopentibiafracturesametaanalysisofrandomizedcontrolledtrials AT xielifeng comparingexternalfixatorsandintramedullarynailingfortreatingopentibiafracturesametaanalysisofrandomizedcontrolledtrials AT liuli comparingexternalfixatorsandintramedullarynailingfortreatingopentibiafracturesametaanalysisofrandomizedcontrolledtrials AT gaoguicheng comparingexternalfixatorsandintramedullarynailingfortreatingopentibiafracturesametaanalysisofrandomizedcontrolledtrials AT zhouping comparingexternalfixatorsandintramedullarynailingfortreatingopentibiafracturesametaanalysisofrandomizedcontrolledtrials AT chudejun comparingexternalfixatorsandintramedullarynailingfortreatingopentibiafracturesametaanalysisofrandomizedcontrolledtrials AT qiudewei comparingexternalfixatorsandintramedullarynailingfortreatingopentibiafracturesametaanalysisofrandomizedcontrolledtrials AT taojun comparingexternalfixatorsandintramedullarynailingfortreatingopentibiafracturesametaanalysisofrandomizedcontrolledtrials |