Management of fracture shaft of tibia by closed interlocking intramedullay nailing non-reaming versus reaming

Abstract

Introduction: Tibia and fibula have the highest incidence of diaphyseal fractures of long bones. Closed intramedulary nailing is the treatment of choice in stabilizing displaced diaphyseal fractures of tibia. Availability of unreamed nails has raised the issue of what effect reaming with intramedullay nailing has on the clinical outcome. The aim of the study was to compare rate of healing of fractures with two techniques of nailing, reaming versus none reaming.

Methods: Fifty acute fractures of shaft of tibia were treated with closed intramedullary interlocking nailing, out of which only 39 patients were available for follow up. Twenty one fractures were treated by reamed and eighteen by un-reamed technique. Patients were followed up till nine months after operation. Displaced closed fractures and Gustilo Type I and Type II open fracture were included in the study.

Results: The time to fracture union averaged 23.29 weeks in un-reamed and 23.33 weeks in reamed group. Thirty eight percent of un-reamed and 19% of reamed fractures united by 12 weeks .There were six (35.29%) delayed union in un-reamed and four (21.05%) delayed union in reamed but all united after dynamization. There was no nonunion. Infection occurred in four patients, three superficial (14%) in reamed group and one deep infection in un-reamed group (5%), there was one case of screw breakage in un-reamed group. There were five malunion (27.77%) in un- reamed and three (14.28%) in reamed group but functional outcome was unaffected.

Conclusion: The study has revealed that both procedures are equivalent in terms of functional outcome and un-reamed has slight advantage over reaming in terms of union and lower rate of infection.