title: Closed and open grade I and II tibial shaft fractures treated by reamed intramedullary nailing.
abstract: OBJECTIVE
  To evaluate the results of closed and open grade I and II tibial shaft fractures treated by reamed nail and unreamed nailing.
  
  
  METHODS
  Between 1997 and 2000, 119 patients with tibial shaft fractures were treated with reamed tibial nails. Postoperatively 96 patients (70 closed and 26 grade I and II open fractures) were followed clinically and radiologically for up to 18 months. The nail was inserted either by patellar tendon splitting or by nonsplitting technique. The nail was inserted after overreaming by 1.5 mm. Postoperatively, patients with isolated tibial fracture were mobilized by permitting partial weight bearing on the injured leg for 6 weeks. Patients with associated ankle fractures were allowed to walk with a Sarmiento cast.
  
  
  RESULTS
  Postoperatively, 6 (6.3%) patients developed a compartment syndrome after surgery. In 48 (50%) cases, dynamization of the nail was carried out after a mean period of 12 weeks for delayed union. Overall, a 90.6% union was obtained at a mean of 24 weeks without difference between closed or open fractures. Two (2.1%) patients with an open grade II fracture developed a deep infection requiring treatment. A 9.4% rate of malunion was observed. Eight (8.3%) patients developed screw failure without clinical consequences. At the last follow-up, 52% of patients with patellar tendon splitting had anterior knee pain, compared to those (14%) who did not have tendon splitting.
  
  
  CONCLUSIONS
  Reamed intramedullary nail is a suitable implant in treating closed as well as grade I and II open tibial shaft fractures.
authors.affiliation: Orthopedic and Traumatology Department, University Hospital of Lausanne, Switzerland.
authors.forename: Ali
authors.initials: A
authors.lastname: Djahangiri
authors.forename: Raffaele
authors.initials: R
authors.lastname: Garofalo
authors.forename: François
authors.initials: F
authors.lastname: Chevalley
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Leyvraz
authors.forename: Michael
authors.initials: M
authors.lastname: Wettstein
authors.forename: Olivier
authors.initials: O
authors.lastname: Borens
authors.forename: Constantin
authors.initials: C
authors.lastname: Schizas
authors.forename: Elyazid
authors.initials: E
authors.lastname: Mouhsine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005594:Fracture Fixation, Intramedullary; D005596:Fractures, Closed / Q000601:surgery*; D005597:Fractures, Open / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome