SynthesisInternational orthopaedics2023
External fixation versus intramedullary nailing for the management of open tibial fracture: meta-analysis of randomized controlled trials.
Synthesis in International orthopaedics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 21 citations in OpenAlex.
- External fixation in severe open tibial shaft fractures: indications, orthoplastic strategy, and infection-aware decision-making.EFORT open reviews · 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
- Comparison of functional recovery between 3D-printed automatic reset splints and traditional fluoroscopy-assisted reduction external fixators in the treatment of tibial shaft fractures.American journal of translational research · 2026Article
- Comparative outcome study of the management of open tibia shaft fractures using Ilizarov frame fixator and linear rail system at University College Hospital, Ibadan, Nigeria.International orthopaedics · 2025Article
- Comparative analysis of bone metabolism and inflammatory markers in tibiofibular fractures following closed reduction and fixation: A retrospective study.Journal of medical biochemistry · 2025Article
- Article
- Measurement of the dynamic axial load-share ratio in vivo could indicate sufficient callus healing in external fixators.BMC musculoskeletal disorders · 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
- Infection rates and risk factors with magnetic intramedullary lengthening nails.Journal of orthopaedics · 2024Article
- Open tibial shaft fracture fixation strategies: intramedullary nailing, external fixation, and plating.OTA international : the open access journal of orthopaedic trauma · 2024Review
- Comparative Analysis of Complication Rates in Tibial Shaft Fractures: Intramedullary Nail vs. Ilizarov External Fixation Method.Journal of clinical medicine · 2024Article
- The loneliness of the local orthopaedic surgeon in disaster zones.International orthopaedics · 2024Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimTibial shaft fractures are the most common type of long-bone fractures. External fixation (EF) and intramedullary nailing (IMN) are widely used surgical techniques for the definitive fixation of open tibial shaft fractures. The aim of this systematic review and meta-analysis was to compare EF to IMN for the definitive fixation of open tibial fractures.
methodsMedline, Embase, and CENTRAL databases were searched for eligible studies. We included randomized controlled trials (RCTs) that compared EF to IMN for skeletally mature adults with open tibial fracture (Gustilo I, II, and III). We evaluated the following outcomes: superficial infection, pin-track infection, deep infection, malunion, nonunion, delayed union, and implant/hardware failure. The risk ratio (RR) was used to represent the desired outcomes. The statistical analysis was performed using the random-effects model.
resultsA total of 12 RCTs that enrolled 1090 participants were deemed eligible for the analysis. EF showed a significantly higher rate of superficial infection, pin track infection, and malunion compared to IMN (RR = 2.30, 95% confidence interval (CI): 1.34 to 3.95; RR = 13.52, 95% CI: 6.16 to 29.66; RR = 2.29, 95% CI 1.41 to 3.73, respectively). No substantial difference was found between EF and IMN in terms of deep infection, nonunion, delayed union, or implant/hardware failure (RR = 1.15, 95% CI 0.67 to 1.98; RR = 0.92, 95% CI 0.77 to 1.10; RR = 1.50, 95% CI 0.98 to 3.33; RR = 0.96, 95% CI 0.36 to 2.60, respectively). DISCUSSION: The findings of our meta-analysis are consistent with the previous systematic reviews excepts for the implant/hardware failure which was found to be significant in favour of IMN by one of the previous reviews.
conclusionThis meta-analysis confirms that IMN is better than EF with respect to clinical outcomes and complication rate for the definitive fixation of open tibial fracture.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.