Chinese Journal of Tissue Engineering Research ›› 2012, Vol. 16 ›› Issue (26): 4812-4816.doi: 10.3969/j.issn.1673-8225.2012.26.013

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Systematic review of reamed intramedullary nailing versus unreamed intramedullary nailing for femoral shaft fractures in adult patients

Wang Xiong, Dai Qi-yi, Li Shu-zhen   

  1. Department of Orthopedics, Affiliated Ruikang Hospital of Guangxi College of Traditional Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China
  • Received:2011-10-25 Revised:2011-12-16 Online:2012-06-24 Published:2013-11-02
  • About author:Wang Xiong★, Studying for master’s degree, Physician, Department of Orthopedics, Affiliated Ruikang Hospital of Guangxi College of Traditional Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China wangxiong62s@126.com

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Abstract:

BACKGROUND: Reamed intramedullary nailing and unreamed intramedullary nailing for the treatment of femoral shaft fractures is still controversial.
OBJECTIVE: To compare the clinical effects of reamed intramedullary nailing versus unreamed intramedullary nailing for femoral shaft fracture and to evaluate the efficiency differences between the two methods.
METHODS: Cochrane central register of controlled trials (No.9 in 2011), Medline (1966-01/2011-09), EMbase (1984-01/2011-09) and CNKI (1979-01/2011-09) were searched by computer for randomized controlled trials (RCTs) that related to reamed intramedullary nailing versus unreamed intramedullary nailing for shaft fracture of femur in the adults. Meta-analysis was performed with software RevMan5.1.2 from the Cochrane collaboration. The study was graded by GRADEpro version3.2.2 software.
RESULTS AND CONCLUSION: Ten RCTs with 1 360 femoral shaft fractures were included containing reamed intramedullary nailing (656 cases) and unreamed intramedullary nailing (704 cases). The Meta-analysis showed that compared with unreamed intramedullary nailing, reamed intramedullary nailing for femoral shift fractures could reduce the nonunion rate (RR=0.20, 95% CI 0.07-0.82, P = 0.02), re-operation rate (RR=0.25, 95% CI 0.11-0.59, P = 0.002) and delayed healing rate (RR=0.30, 95%CI 0.14-0.64, P = 0.002), for the fixation failure rate (RR = 0.68, 95% CI 0.28-1.70, P = 0.41), mortality rate (RR 0.94, 95% CI 0.19-4.58, P = 0.94) and incidence rate of respiratory distress syndrome (RR 1.53, 95% CI 0.37-6.32, P = 0.78) had no significant statistical difference. It is indicated that reamed intramedullary nailing has better clinical effects than unreamed intramedullary nailing for femoral shaft fracture in the adults.

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