Comparing Intramedullary Nailing, External Fixation, and External Fixation followed by Intramedullary Nailing as management for open fractures of the tibial shaft: a Systematic Review

Abstract

Background: The treatment of open fractures of the tibial shaft is often a dilemma since it requires particular caution and individual assistance for each case. Methods and Findings: Systematic review of the literature was conducted on the following databases: PubMed and VHL from 2000 to 2013 aiming to compare Intramedullary Nailing (IM Nailing), External Fixation (EF), and EF followed by IM Nailing in the treatment of open fractures of the tibial shaft. After analysis by inclusion criteria 24 articles met the eligibility criteria. The healing time was under 32 weeks, and the nonunion and defective healing rates were under 13.35% and 16.6%, respectively. The infection rate ranged from 3% to 53% for patients treated with EF as definitive management; from 0% to 22% for those treated with IM Nailing as definitive management; and from 0% to 16.7% for those who underwent EF followed by IM Nailing. Conclusion: The cases treated with EF as definitive management presented shorter healing time as for the analyzed samples. The nonunion cases with greater percentages were those of EF followed by IM Nailing. The studies using IM Nailing as definitive management presented more healing cases defective. Even though few studies analyze hospital stay, it was found to be shorter in the sample treated with EF as definitive management.Â