Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective, randomized study with 3.8 years' follow-up.
OBJECTIVE
To determine if any differences exist in healing and complications between reamed and unreamed nailing in patients with tibial shaft fractures.


METHODS
Prospective, randomized.


METHODS
Level 1 trauma center.


METHODS
Forty-five patients with displaced closed and open Gustilo type I-IIIA fractures of the central two thirds of the tibia.


METHODS
Stabilization of tibial fractures either with a slotted, stainless steel reamed nail or a solid, titanium unreamed nail.


METHODS
Nonunions, time to fracture healing, and rate of malunions.


RESULTS
The average time to fracture healing was 16.7 weeks in the reamed group and 25.7 weeks in the unreamed group. The difference was statistically significant (P = 0.004). There were three nonunions, all in the unreamed nail group. Two of these fractures healed after dynamization by removing static interlocking screws. The third nonunion did not heal despite exchange reamed nailing 2 years after the primary surgery and dynamization with a fibular osteotomy after an additional 1 year. There were two malunions in the reamed group and four malunions in the unreamed group. There were no differences for all other outcome measurements.


CONCLUSIONS
Unreamed nailing in patients with tibial shaft fractures may be associated with higher rates of secondary operations and malunions compared with reamed nailing. The time to fracture healing was significantly longer with unreamed nails.
Larsen
Leif Børge
LB
Orthopaedic Center, Ullevål University Hospital, Oslo, Norway. leifborge.larsen@ulleval.no
Madsen
Jan Erik
JE
Høiness
Per Reidar
PR
Øvre
Stein
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D011336:Probability; D011446:Prospective Studies; D011859:Radiography; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome