| Objective: To determine the effect of external fixation versus intramedulllary nailing for the type II, type III A and typeIIIB tibial shaft fractures on the rates of complication. Methods: We searched the specialized trials registered in Cochrane truma group, Cochraneliabrary(CCTR), MEDLINE (1966-2006.3), EMBASE(1980- 2006.3), PUBMED (1966-2006.3),and we handsearched some Chinese orthoopaedics Journals . Randomized controlled trials and quasi-randomized trails of external fixation versus intramedullary nailing for tibial shaft fractures were included .The quality of trials was critical assessed. RevMan 4.2.8 software was used for data analysis . Result: One RCTs and two CCTs of external fixation versus intramedullary nails for the type II ,type IIIA and typeIIIB tibial shaft fractures were included. Three studies including a total of 104 patients met the inclusion criteria for the review . The results of meta-analysis showed that external fixation for tibial shaft fractures increased the rates of malunion [RR2.85,95%CI (1.20,6.79) ,p=0.021.The rate of disunion [RR2.90,95% (1.01,8.34), P=0.05].In aspects of complications, including the rates of infection, the rates of ostemylitis and the rates of second operation, external fixation versus intramedullary nails,there are no evident differences in statistics. Conclusion: Compared with external fixation for the typeII, type IIIA and type IIIB tibial shaft fractures , intramedullary nails don't increased the rates of infection,the rates of disunion, the rates of ostemylitis and the rates of second operation. However, the intramedullary nails group has less malunion. But further studies are needed to determine the effects of external fixation and intramedullary nails on these outcomes, especially when patient have GustiloIIIC fractures.Another important point is the systematic review included few patients, further studies are needed to enchance the conclusion. |
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