SynthesisJournal of orthopaedic surgery and research2023
Comparing external fixators and intramedullary nailing for treating open tibia fractures: a meta-analysis of randomized controlled trials.
Synthesis in Journal of orthopaedic surgery and research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.
- Updated Meta-Analysis of Randomized Controlled Trials Comparing External Fixation to Intramedullary Nailing in the Treatment of Open Tibial Fractures.Medicina (Kaunas, Lithuania) · 2023Pooled it
- Primary reamed intramedullary nailing of tibial shaft fractures in a low-resource setting: a prospective comparative study of multifragmentary (AO/OTA 42 C) versus simple and wedge (AO/OTA 42 A/B) fractures.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Open Tibial Fractures Part 2: A Narrative Review of Definitive Treatment and Potential Applicability to the Southern African Context.Orthopedic research and reviews · 2026Review
- Management of Ipsilateral Tibia and Fibula Shaft Fracture with Trimalleolar Fracture: A Rare Case Report.Journal of orthopaedic case reports · 2025Article
- Evaluation of the effectiveness of suprapatellar versus infrapatellar approach in intramedullary nailing for the treatment of tibial fractures.European journal of medical research · 2025Article
- Marginal bone resection and immediate internal fixation in multidrug resistant chronic septic nonunions of lower limb long bones: a case series.International orthopaedics · 2025Article
- What influences post-operative opioid requirements for tibial fractures?British journal of pain · 2024Article
- A Scoping Review on the Management of Open Fractures in African Trauma and Orthopaedics Centres.Cureus · 2024Article
- Temporary Stabilization of Tibia Fractures: Does External Fixation or Temporary Plate Fixation Result in Better Outcomes?The Iowa orthopaedic journal · 2024Article
- Comparison of Nanocrystalline Hydroxyapatite Bone Graft with Empty Defects in Long Bone Fractures: A Retrospective Case-Control Study.Medical science monitor : international medical journal of experimental and clinical research · 2023Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundExternal 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.
methodsA 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.
resultsNine 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).
conclusionsCompared 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.
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