title: Operative fixation for complex tibial fractures.
abstract: BACKGROUND
  The management of open tibial shaft fractures remains challenging. Intramedullary nailing and external fixation are the most commonly used fixation techniques although the optimal fixation technique remains unresolved. In this article the outcomes of these two surgical  techniques are compared.
  
  
  METHODS
  A comprehensive literature search was conducted through MEDLINE(®) using Ovid(®) and MeSH (Medical Subject Heading) terms for articles published in the English literature between 1999 and 2009. The outcome measures compared were  time to fracture union, infection rates and complications.
  
  
  RESULTS
  Forty-one studies were identified, of which only three met the inclusion criteria. The average time to union was variable. Delayed union and non-union appeared to be more prevalent in the external fixator group although  this was not statistically significant. Both techniques were associated with secondary procedures as well as infection.
  
  
  CONCLUSIONS
  The current literature indicates little evidence to suggest the superiority of one fixation technique over another for open tibial fractures.
authors.affiliation: Department of Physiotherapy, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK. amanda.hutchinson@imperial.nhs.uk
authors.forename: A J P
authors.initials: AJ
authors.lastname: Hutchinson
authors.forename: A E
authors.initials: AE
authors.lastname: Frampton
authors.forename: R
authors.initials: R
authors.lastname: Bhattacharya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016267:External Fixators; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D013978:Tibial Fractures / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult