Importance of the Topic
Tibial shaft fractures are the
most common of long bone
fractures [7, 13], occurring in
17 per 10,000 persons annually [6] and
this rate is growing as low-and middleincome countries become increasingly
motorized [11]. Tibial shaft fractures
typically are high-energy injuries, and
often are complicated by deep infection, nonunion, malunion, and
compartment syndrome [6]. These
complications can lead to prolonged
pain and disability, and they consume
substantial healthcare resources [1,
10].
Current surgical options include
external fixation, plate fixation, and
intramedullary nailing. Survey data
indicate nearly 90% of orthopaedic
trauma surgeons prefer intramedullary
nailing for both open and closed tibial
shaft fractures, but there is considerable variability regarding the preferred
surgical approach, method of interlocking, nail material, and decision to
ream the medullary canal [2, 5].
This Cochrane review determined
whether different methods and types of
intramedullary nailing were associated
with unique benefits and harms when
treating adults with tibial shaft fractures. Five different comparisons of
interventions were assessed across 11
separate trials in 2093 participants
(2123 fractures). The authors found
insufficient evidence to determine the
effects of treatment between most of
the comparisons of interest, with the
exception of reamed versus unreamed
nailing. Reaming was associated with
a lower risk of implant failure, and
incidence of major reoperations related
to nonunion in closed compared to
open fractures (low-quality evidence).