LEI Zhong 1 , BAI Jingping 2 , WU Taixiang 3
  • 1. Postgraduate 2003, XingJing medical university, Urimqi, 8300542. The third affiliated hospital of XinJing medical university, Urimqi, 8300113. Chinese evidence-based Medicine Center/clinical Epidemiology resource and Training Center, West China hospital, Sichuan University, Chengdu 610041, China;
LEI Zhong, Email: xjzlyy@xjzlyy.com
Tibial fracture; External fixation; Intramedullary nailing; Randomized controlled trials; Systematic review
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Objective 　To determine the efficacy and safety of external fixation versus intramedulllary nailing in the treatment of adult tibial shaft fracture.
Methods 　We searched the specialized trials register of The Cochrane Collaboration’s Bone, Joint and Muscule Trauma Group, The Cochrane Library (CENTRAL), MEDLINE (1966 to March 2006), EMBASE (1980 to March 2006) and PUBMED (1966 to March 2006). We also handsearched some Chinese orthopedic journals. Randomized controlled trials (RCTs) and quasi-randomized trials (quasi-RCTs) comparing external fixation versus intramedullary nailing for tibial shaft fractures in adults were included. The quality of these trials was critically assessed. We used the Cochrane Collaboration’s RevMan 4.2.8 for data analyses.
Result 　Three RCTs and two quasi-RCTs involving a total of 279 patients were included. The results of meta-analyses showed that external fixation for tibial shaft fractures in adults may increase the infection rate [RR 2.45, 95%CI (1.31,4.61), P=0.005], and the malunion rate [RR 2.85, 95%CI (1.20,6.79), P=0.02] but may reduce the duration of hospitalization [RR –5.50, 95%CI (–6.99,–4.01)]. The nonunion rate, delayed healing rate, and healing time, were comparable between external fixation and intramedulllary nailing.
Conclusion 　The trials available for this systematic review are too few and small for reliable estimates of the relative effects of external fixation and intramedulllary nailing. Further studies are needed to determine these effects , especially for patients who have GustiloШ C fractures.

Citation： LEI Zhong,BAI Jingping,WU Taixiang. External Fixation or Intramedullary Nailing For Tibial Shaft Fractures in Adults: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2007, 07(1): 45-52. doi: Copy