title: Unreamed Intramedullary Nailing is a better alternative than External Fixator for Gustilo grade IIIB Tibial Fractures based on a meta-analysis.
abstract: OBJECTIVE
  There remains a controversy between unreamed intramedullary nailing and external fixation to treat Gustilo grade IIIB tibial fractures. To evaluate the comparative effectiveness and safeness of both methods for this type of fracture, we performed this meta-analysis.
  
  
  METHODS
  Relevant original studies were searched in MEDLINE, EMBASE, China National Knowledge Infrastructure, and Cochrane Central Database (all through February 2014). Studies included in this meta-analysis had to compare the effectiveness or complications and provided sufficient data of interest. The patients treated by both methods were similar statistically in demography and injury mechanism. The Stata 11.0 was used to analyze all data.
  
  
  RESULTS
  Six studies involving 163 participants were included. Unreamed intramedullary nailing was associated with reduced time to union (standardized mean difference, -1.14; 95% confidence interval, -2.04 to -0.24) and lower rates of superficial infection (odds ratio: 0.39; 95% confidence interval: 0.17-0.87) and malunion (odds ratio: 0.27; 95% confidence interval: 0.09-0.78). However, there were no significant differences in other adverse events including delayed union, non-union, deep infection, and fixation failure.
  
  
  CONCLUSIONS
  The existing evidence supports unreamed intramedullary nailing to be a better method for treating Gustilo grade IIIB tibial fractures, and this might aid in the management of this sever injury.
authors.affiliation: Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, P.R. China.
authors.forename: F
authors.initials: F
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, P.R. China.
authors.forename: W
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, P.R. China.
authors.forename: W
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, P.R. China.
authors.forename: Y
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, P.R. China Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, P.R. China dryzzhang@126.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D005592:Fracture Fixation / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D015233:Models, Statistical; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: Gustilo grade IIIB; external fixator; meta-analysis; open tibial fractures; unreamed intramedullary nailing