title: Reamed or unreamed intramedullary nailing for tibial fractures: a meta-analysis.
abstract: OBJECTIVE
  To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.
  
  
  METHODS
  Literature reports in both Chinese and English languages were retrieved (from the earliest available records to October 1, 2013) from the PubMed, FMJS, CNKI, Wanfang Data using randomized controlled trials (RCTs) to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis.
  
  
  RESULTS
  A total of 12 randomized controlled trials, comprising 985 patients (475 in the unreamed group and 510 in the reamed group), were eligible for inclusion in this meta-analysis. The results of meta-analysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection (RR=0.64; 95%CI, 0.39 to 1.07; P=0.09), compartment syndrome (RR=1.44; 95%CI, 0.8 to 2.41; P=0.16), thrombosis (RR=1.29; 95%CI, 0.43 to 3.87; P=0.64), time to union (WMD=5.01; 95%CI, -1.78 to 11.80; P=0.15), delayed union (nonunion) (RR=1.56; 95%CI, 0.97 to 2.49; P=0.06), malunion (RR=1.75; 95%CI, 1.00 to 3.08; P=0.05) and knee pain (RR=0.94; 95%CI, 0.73 to 1.22; P=0.66). But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group (RR=4.29; 95%CI, 2.58 to 7.14; P<0.00001).
  
  
  CONCLUSIONS
  There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures, but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.
authors.affiliation: Graduate School, Fujian University of Traditional Chinese Medicine, Graduate School, Fuzhou 350122, China.
authors.forename: Guang-Shu
authors.initials: GS
authors.lastname: Yu
authors.forename: Yan-Bin
authors.initials: YB
authors.lastname: Lin
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Zhi-Qing
authors.initials: ZQ
authors.lastname: Xu
mesh_terms: D001858:Bone Nails; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*