title: A meta-analysis of external fixator versus intramedullary nails for open tibial fracture fixation.
abstract: BACKGROUND
  To compare the clinical outcomes of external fixator (EF) and intramedullary nails (IN) in the treatment of open tibial fractures.
  
  
  METHODS
  We searched seven electronic databases (PubMed, MEDLINE, EMBASE, OVID, Cochrane library, CNKI, and CBM) for trials of tibial fracture fixation published from 1980 to 2013. The indicators including postoperative infection, malunion, nonunion, soft tissue injury, delayed healing, and healing time were used for quantitative outcome assessments.
  
  
  RESULTS
  A total of nine trials involving 532 patients (EF, n = 253; IN, n = 279) with open tibia fractures were included in this meta-analysis. The results indicated that the patients undergoing IN had lower incidence of postoperative infection (risk radio [RR] = 3.85; 95% confidence intervals [CI], 2.67-5.54; P < 0.0001), malunion (RR = 2.31; 95% CI, 1.40-3.81; P = 0.001), nonunion (RR = 1.41; 95% CI, 1.06-1.88; P = 0.02) and less healing time (weighted mean difference [WMD] = 6.19; 95% CI, 1.42-10.96; P = 0.01) compared with EF. However, regarding to the soft tissue injury (RR = 0.74; 95% CI, 0.34-1.62; P = 0.45) and delayed healing (RR = 1.38; 95% CI, 0.79-2.43; P = 0.26), there is no significantly difference between EF and IN approach.
  
  
  CONCLUSIONS
  In conclusion, the use of IN is more effective than EF and may be considered as first-line approach in fixation of open tibial fractures.
authors.forename: Xian
authors.initials: X
authors.lastname: Xu
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.forename: Lin
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Traumatic Orthopedics, East Hospital, No,150 Jimo Road, Pudong New District, Shanghai 200120, China. weiwuortho@hotmail.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Wu