Open and closed reduction methods for intramedullary nailing of femoral shaft fractures: A systematic review and meta-analysis of comparative studies

IntroductionClosed reduction and intramedullary nailing is the preferred surgical intervention for femoral shaft fractures. Open involves opening fracture site performed in various circumstances. Comparative studies of approaches have conflicting results. We sought to compare outcomes complications open closed fractures.Materials methodsFollowing Preferred Reporting Items Systematic Reviews Meta-analysis (PRISMA) guidelines, a systematic review comparative included databases registers PubMed (Medline), Embase, Scopus, Cochrane Central (PROSPERO registration ID: CRD42022325382). Additional were identified through hand citation searching. Two reviewers independently extracted data. The standardized mean difference 95% confidence intervals determined continuous variables, whereas odds ratios assessed dichotomous variables.ResultsClosed had higher pooled union rate (93.93%, 92.02%), an increased ratio (OR = 1.624 [95% CI: 1.004, 2.624]; p .048), faster time (SMD −0.292 −0.549, −0.0.035]; .026). There no differences operative 0.128 −0.700, 0.956] .762) or overall complication 1.314 0.966, 1.787] .082).ConclusionsClosed has advantage rates, quicker union, lower infection compared remains reasonable alternative with acceptable rates when not feasible.