Level I evidence studies
| Characteristic | Smekal et al. (43) | Ferran et al. (44) | Judd et al. (18) |
|---|---|---|---|
| Design | RCT: intramedullary fixation v. nonoperative treatment | RCT: intramedullary fixation v. plate fixation | RCT: intramedullary fixation v. nonoperative treatment |
| No. of intramedullary fixations | 60 | 17 | 29 |
| Type of intramedullary fixation | Titanium endomedullary nail | Rockwood pin | Hagie pin |
| Follow-up, mean (range) mo | 24 (22–27) | 12 (5–28) | 3 (1–12) |
| Major complication rate, no. (%) | |||
| Bone-healing problem | |||
| Nonunion | 0 | 0 | 1 (3) |
| Delayed union | 2 (3) | 0 | 1 (3) |
| (Symptomatic) malunion | 0 | 0 | NA |
| Infection, deep | NA | NA | 2 (7) |
| Implant breakage/failure/irritation, mechanical failure | 2 (3) | 1 (6) | 1 (3) |
| Refracture after pin removal | 1 (2) | NA | 2 (7) |
| Minor complication rate, no. (%) | |||
| Implant breakage/failure/irritation | |||
| Irritation | 5 (5) | 1 (6) | 9 (31) |
| Migration/telescoping | 7 (12) | NA | NA |
| (Medial/lateral) protrusion | 12 (20) | NA | NA |
| Infection, wound | 1 (2) | 0 | 4 (14) |
| Routine nail removal | NA | 17 (100) | 26 (90) |
| Nonroutine nail removal | 0 | 0 | 3 (10) |
| Neurovascular problem | |||
| Brachial plexus symptoms | 0 | 2 (12) | 1 (3) |
| Regional pain syndrome | 0 | 0 | NA |
| Intramedullary fixation device shortening | 12 (20) | NA | NA |
NA = not applicable (complication not mentioned in study); RCT = randomized controlled trial.