Original Research ARTICLE
Multiple Comparisons of the Efficacy and Safety for Seven Treatments in Tibia Shaft Fracture Patients
- 1Tianjin Hospital, China
- 2Shandong Wendeng Osteopathic Hospital, China
- 3Weifang Chinese Medicine Hospital, China
- 4Shandong Academy of Medical Sciences (SDAMS), China
- 5Affiliated Hospital of Shandong University of Traditional Chinese Medicine, China
Background: Tibia shaft fracture is the most common long bone fractures, with two general types, open fracture and close fracture. However, there is no universally accepted guideline suggesting which treatment to use under certain circumstances. Therefore, a comprehensive network meta-analysis (NMA) is demanded to summarize existing studies and provide a more credible data-based medical guideline.
Methods: Available literatures were identified by searching the internet medical database with relevant key terms. For studies meeting the inclusion and exclusion criteria, baseline, intervention and outcomes of each treatment were extracted. Comparative connection of studies was demonstrated by net plots. Continuous variables and binary variables were reported as mean difference (MD) and odds ratio (OR) with 95% credible interval (CrI), respectively. The comparison of direct and indirect outcome and their P-value were listed in the node-splitting table. Treatments for each endpoint were ranked by their surface under the cumulative ranking curve (SUCRA) value. Heat plot was performed to illustrate the contribution of raw data and the inconsistency between direct and indirect comparison.
Results: According to the search strategy, 697 publications were identified and 25 records were kept, with 3032 patients of tibia shaft fracture involved. And seven common surgical or non-surgical treatments, including reamed intramedullary nailing (RIN), un-reamed intramedullary nailing (UIN), minimally reamed intramedullary nailing (MIN), ender nailing (EN), external fixation (EF), plate and cast, were compared, in terms of time to union, reoperation, nonunion, malunion, infection and implant failure. Plate performed relatively better for time to union, while cast might be the best choice in close cases for reducing the risks of reoperation, nonunion, malunion and infection. For preventing implant failure, EN seemed to be better.
Conclusion: Cast might have the highest probability to be the optimal choice for tibia shaft fracture in close cases, and reamed intramedullary nailing ranked second.
Keywords: efficacy, Network meta-analysis, randomized controlled trial, treatments, Tibial shaft fracture
Received: 10 Sep 2018;
Accepted: 15 Feb 2019.
Edited by:Brian Godman, Karolinska Institute (KI), Sweden
Reviewed by:Jochen Fleischmann, Johnson & Johnson (Germany), Germany
Kurt Neumann, Independent researcher, Hungary
Copyright: © 2019 Li, Yu, Wu, Zhang and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Prof. Liang Ma, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China, firstname.lastname@example.org