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The primary outcome was the union rate; the secondary outcomes were time to union, nonunion, malalignment, revision, and infection. This review was conducted in line with PRISMA guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 12 studies with 1299 (1346 IMN cases) patients were included, with a mean age of 32.3\u2009\u00b1\u20093.25. The average follow-up was 2.3\u2009\u00b1\u20091.45\u00a0years. There was a statistically significant difference in union rate (OR, 0.66; 95% CI, 0.45\u20130.97;\n                      <jats:italic>p<\/jats:italic>\n                      -value, 0.0352), nonunion (OR, 2.06; 95% CI, 1.23\u20133.44;\n                      <jats:italic>p<\/jats:italic>\n                      -value, 0.0056), and infection rate (OR, 1.94; 95% CI, 1.16\u20133.25;\n                      <jats:italic>p<\/jats:italic>\n                      -value, 0.0114) between the open-reduction and closed-reduction groups in favour of the latter. However, malalignment was significantly higher in the closed-reduction group (OR, 0.32; 95% CI, 0.16\u20130.64;\n                      <jats:italic>p<\/jats:italic>\n                      -value, 0.0012), whereas time to union and revision rates were similar (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009NS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study showed that closed-reduction and IMN had more favourable union rate, nonunion, and infection rates than the open-reduction group, yet malalignment was significantly less in the open-reduction group. Moreover, time to union and revision rates were comparable. However, these results must be interpreted in context due to confounding effects and the lack of high-quality studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-023-05740-x","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T23:29:16Z","timestamp":1677799756000},"page":"3031-3041","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Open versus closed intramedullary nailing of femur shaft fractures in adults: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"47","author":[{"given":"Loay A.","family":"Salman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah","family":"Al-Ani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed F. 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No ethical approval is required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable as this is a review article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable as this is a review article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}