title: Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective, randomized study with 3.8 years' follow-up.
abstract: 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.
authors.affiliation: Orthopaedic Center, Ullevål University Hospital, Oslo, Norway. leifborge.larsen@ulleval.no
authors.forename: Leif Børge
authors.initials: LB
authors.lastname: Larsen
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Madsen
authors.forename: Per Reidar
authors.initials: PR
authors.lastname: Høiness
authors.forename: Stein
authors.initials: S
authors.lastname: Øvre
mesh_terms: 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