PubMed · 1978597
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C Burri. 1990. [Stability in post-traumatic osteitis].. https://pubmed.ncbi.nlm.nih.gov/1978597/
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Fritz König (1866-1952) was 1918-1935 ordinary professor of surgery at the University of Wuerzburg. A main interest of his work was the technique and indication of osteosynthesis. Since 1900 he investigated methods (wire suture, intra- and extramedullary splint, external fixator, plate) and materials (ivory, steel; wire, screws). All his life he aimed to standardize the technique of osteosynthesis, to work out and spread clear indications for the surgical treatment of fractures, and to carry his point against the resistance of the social accident insurance caused by bad results of a lot of surgeons. His importance is not based on the invention of a great deal of instruments but on his endeavour for the fundamentals of osteosynthesis.
We have systematically reviewed the effect of alternative methods of stabilisation of open tibial fractures on the rates of reoperation, and the secondary outcomes of nonunion, deep and superficial infection, failure of the implant and malunion by the analysis of 799 citations on the subject, identified from computerised databases. Although 68 proved to be potentially eligible, only eight met all criteria for inclusion. Three investigators independently graded the quality of each study and extracted the relevant data. One study (n = 56 patients) suggested that the use of external fixators significantly decreased the requirement for reoperation when compared with fixation with plates. The use of unreamed nails, compared with external fixators (five studies, n = 396 patients), reduced the risk of reoperation, malunion and superficial infection. Comparison of reamed with unreamed nails showed a reduced risk of reoperation (two studies, n = 132) with the reamed technique. An indirect comparison between reamed nails and external fixators also showed a reduced risk of reoperation (two studies) when using nails. We have identified compelling evidence that unreamed nails reduced the incidence of reoperations, superficial infections and malunions, when compared with external fixators. The relative merits of reamed versus unreamed nails in the treatment of open tibial fractures remain uncertain.
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