Non-operative treatment of tibial fractures - Chinmay Gupte 27/11/2001

Title

Closed fractures of the tibial shaft: a meta-analysis of three methods of treatment

Author

Littenberg, B et al

Reference

JBJS 1998 80A 174-183

Summary

Reviewed 2372 studies; excluded polytrauma, open fractures, intraarticular fractures. Compared cast, ORIF, and nailing. Only 19 studies included.

Results: cast had lower infection rate (by 5.8%); ORIF higher rate of union at 20wks (by 18.07%). Functional results inconclusive.

Critique

Shows lack of good studies. Initially only read abstracts. Some intraarticular fractures included

Title

Conservative management or nailing for tibial shaft fractures. A randomised prospective trial

Author

Hooper et al; NZ

Reference

JBJS 1991 73B 83-5

Summary

Randomly assigned displaced tibial fractures to long leg POP (n=33) and patellar tendon bearing cast after 4 weeks, or closed im nailing.

Stringent inclusion criteria (see text)

Results: time to union : 16wks op cf 18weeks conservative

Less malunion or shortening in operated group

Increased inpatient stay in operated group

Conclusion: displaced fractures better treated with nailing

Critique

Good randomisation. But their policy was to operate even before study. ?Subjective bias. Static or dynamic nailing used.