title: Reamed interlocking intramedullary nailing for the treatment of tibial diaphyseal fractures and aseptic nonunions. Can we expect an optimum result?
abstract: The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9 years. No correlation was found between union and nail diameter (P = 0.501) or the number of locking screws used (P = 0.287). Nail dynamization was effective in 82% of fractures. Locking screw(s) breakage was associated with nonunion in 25% of cases. Bone grafting during IM nailing was found not to increase the healing rate in tibial nonunions (P = 0.623). None of the IM nails were removed or revised due to infection. A dropped hallux and postoperative compartment syndrome were found in 0.8 and 1.6% of cases, respectively. Anterior knee pain was reported in 42% of patients but nail removal did not alleviate the symptoms in almost half. This series confirms the place of reamed intramedullary nailing for the vast majority of tibial diaphyseal fractures. It provides an optimum outcome and minimizes the need for supplementary bone grafting in aseptic nonunions.
authors.affiliation: 1st Orthopaedic Department of Aristotle, University of Thessaloniki, Thessaloniki, Greece, byronchalidis@gmail.com.
authors.forename: Byron E
authors.initials: BE
authors.lastname: Chalidis
authors.forename: George E
authors.initials: GE
authors.lastname: Petsatodis
authors.forename: Nick C
authors.initials: NC
authors.lastname: Sachinis
authors.forename: Christos G
authors.initials: CG
authors.lastname: Dimitriou
authors.forename: Anastasios G
authors.initials: AG
authors.lastname: Christodoulou
references.citation: J Orthop Trauma. 2000 Nov;14(8):554-8
references.pmid: 11149501
references.citation: J Bone Joint Surg Br. 2001 Jan;83(1):62-8
references.pmid: 11245540
references.citation: Instr Course Lect. 2006;55:389-401
references.pmid: 16958474
references.citation: Arch Orthop Trauma Surg. 1990;109(6):314-6
references.pmid: 2073449
references.citation: J Orthop Trauma. 1990;4(3):323-30
references.pmid: 2231132
references.citation: J Bone Joint Surg Br. 1995 May;77(3):407-11
references.pmid: 7744925
references.citation: J Orthop Trauma. 2004 Feb;18(2):96-101
references.pmid: 14743029
references.citation: J Orthop Trauma. 2000 Mar-Apr;14(3):187-93
references.pmid: 10791670
references.citation: J Orthop Trauma. 1994 Oct;8(5):373-82
references.pmid: 7996319
references.citation: J Bone Joint Surg Am. 2002 Apr;84(4):580-5
references.pmid: 11940618
references.citation: J Orthop Trauma. 2007 Jul;21(6):381-5
references.pmid: 17620996
references.citation: J Bone Joint Surg Br. 1990 May;72(3):395-7
references.pmid: 2341435
references.citation: J Bone Joint Surg Am. 1997 Mar;79(3):334-41
references.pmid: 9070520
references.citation: J Bone Joint Surg Br. 1999 May;81(3):481-4
references.pmid: 10872371
references.citation: J Bone Joint Surg Br. 1995 May;77(3):490-3
references.pmid: 7744943
references.citation: J Orthop Res. 2004 Nov;22(6):1271-5
references.pmid: 15475208
references.citation: J Bone Joint Surg Am. 1997 May;79(5):640-6
references.pmid: 9160935
references.citation: J Bone Joint Surg Am. 2007 Jan;89(1):177-88
references.pmid: 17200326
references.citation: Clin Orthop Relat Res. 1997 May;(338):182-91
references.pmid: 9170379
references.citation: Bone. 2005 Jan;36(1):74-83
references.pmid: 15664005
references.citation: Clin Orthop Relat Res. 2006 Aug;449:303-7
references.pmid: 16702914
references.citation: J Trauma. 1993 Feb;34(2):185-92
references.pmid: 8459454
references.citation: J Trauma. 1984 Aug;24(8):742-6
references.pmid: 6471139
references.citation: J Orthop Trauma. 2004 Mar;18(3):144-9
references.pmid: 15091267