External Fixation versus Unreamed Tibial Intramedullary Nailing for Open Tibial Fractures: A Meta-analysis of Randomized Controlled Trials.

Controversy exists over whether the use of external fixation (EF) or unreamed tibial intramedullary nailing (UTN) is optimal for the treatment of open tibial fractures. The aim of this study was to compare clinical outcomes in terms of postoperative superficial and deep infection, malunion, delayed union, nonunion and hardware failure between these two treatment methods. So a systematic review and meta-analysis was performed. All available randomized controlled trials that compared the clinical results of EF to those of UTN were obtained and the reported numbers of citations for each observed item were extracted to perform data synthesis. Six published randomized controlled trials with a total of 407 cases fulfilled all inclusion criteria. Data analysis revealed that UTN reduced the incidence rates of superficial infection and malunion after fixation compared with EF. However, EF led to a significant reduction in hardware failure. For postoperative deep infection, delayed union and nonunion, the treatment effects were similar between these two groups. Therefore, we recommend UTN over EF for the management of open tibial fractures. However, patients' postoperative weight bearing should be controlled to avoid hardware failure.