Eficacia de los clavos intramedulares versus fijación externa para el tratamiento de las fracturas en diafisis tibial en los adultos: revisión sistemática

Abstract

Background: For a long time, the tibia has been the most frequently fractured long bone, which remains the case in many developing and transitioning countries. The incidence is approximately 16.5 per 100,000 inhabitants per year, with a higher prevalence among males. The extent of soft tissue injury determines whether the fracture is classified as open or closed, as well as its treatment, which may be conservative or surgical. Surgical treatment is the most commonly used, with two main options: intramedullary nailing and external fixation. Objective: To evaluate the comparative efficacy of intramedullary nailing versus external fixation for the treatment of diaphyseal tibial fractures in adults through a systematic literature review. Method: A quantitative and qualitative systematic review was conducted following the PRISMA 2020 guidelines. The literature search was carried out using ScienceDirect, PubMed, and Scopus. The risk of bias was assessed using the RoB 2.0 tool, and data were analyzed with RevMan software. Results: Intramedullary nailing demonstrated greater efficacy, with shorter consolidation time and a better safety profile. However, external fixation remains indicated in specific cases, such as type IIIB and IIIC fractures according to the Gustilo-Anderson classification. Keywords: diaphyseal tibial fractures, intramedullary nailing, external fixation, postoperative complications