Which Surgical Treatment for Open Tibial Shaft Fractures Results in the Fewest Reoperations? A Network Meta-analysis

This report has been verified by one or more authors of the original publication.

この研究はハイインパクトの可能性があります。 OEのAI駆動型ハイインパクト指標は、論文が掲載されたジャーナルと論文自体の科学的内容の両方からのシグナルを統合することで、論文が持つ可能性の高い影響力を推定します。 最先端の自然言語処理を用いて開発されたOEハイインパクトモデルは、ジャーナルのインパクトファクターのみよりも、研究の将来の引用実績をより正確に予測します。 これにより、臨床的に意義のある研究をより早く認識することが可能になり、読者は将来の診療を形成する可能性が最も高い論文に集中することができます。

A comprehensive review and network meta-analysis was conducted looking at the complication rates requiring reoperation for all stabilization techniques for open tibial shaft fractures (Gustilo Types I – IIIB). Treatments evaluated were plate fixation, external fixation (by any method), reamed and unreamed intramedullary nailing, and Ender intramedullary nailing. Fourteen trials including 1279 patients demonstrated that unreamed intramedullary nailing had highest likelihood of being the superior treatment (Sucra score 86.3% versus 54.4% for reamed intramedullary nailing). When considering unreamed versus reamed nailing, there was inconsistency between direct (head-to-head trials) and indirect evidence (network estimates generated from trials with common comparators). Direct evidence was therefore considered best evidence and showed a nonsignificant trend toward reduced complications with unreamed over reamed nailing (OR, 0.74; 95% CI, 0.45–1.24; moderate confidence). Unreamed nailing was also associated with a much lower complication rate than external fixation (network estimate OR, 0.38, 95% CI, 0.23–0.62; moderate confidence). All other comparison between other fixation methods were based on low or very low quality evidence but in general favored unreamed nailing.