The SPRINT trial is a multicenter blinded RCT of 1319 adults with tibial shaft fractures randomized to reamed versus unreamed intramedullary nailing across 29 centers. It asks whether reaming technique affects reoperation and complication rates at 12 months, analyzed separately for open and closed fracture patterns. This is the largest trial ever conducted on this question, enrolling more patients than all prior trials combined.
The reamed-versus-unreamed debate dominated tibial fracture management for decades, with prior meta-analyses suggesting reamed nailing cut nonunion risk nearly in half — but those trials lacked concealed randomization, blinded adjudication, and standardized reoperation criteria, making their conclusions unreliable.
SPRINT changes how you select technique at the time of index fixation: use reamed nailing for closed tibial shaft fractures, where it reduces the composite complication rate. For open fractures, either technique is equivalent. Don't feel compelled to default to unreamed.
When a tibial nail patient returns at 3–4 months without clear healing, this paper is why you wait: the 6-month reoperation embargo was associated with a nonunion rate of only 4.6%, roughly half of historical figures. Patience is a treatment.
The dominant caveat: the closed fracture benefit is driven by dynamization, not by bone grafting or implant exchange. If you and your patient consider dynamization unimportant, the case for reamed nailing in closed fractures becomes less compelling. And the trial itself acknowledges it provides little evidence of superiority for the more patient-important outcomes.
The SPRINT trial is a multicenter blinded RCT of 1319 adults with tibial shaft fractures randomized to reamed versus unreamed intramedullary nailing across 29 centers. It asks whether reaming technique affects reoperation and complication rates at 12 months, analyzed separately for open and closed fracture patterns. This is the largest trial ever conducted on this question, enrolling more patients than all prior trials combined.
The reamed-versus-unreamed debate dominated tibial fracture management for decades, with prior meta-analyses suggesting reamed nailing cut nonunion risk nearly in half — but those trials lacked concealed randomization, blinded adjudication, and standardized reoperation criteria, making their conclusions unreliable.
SPRINT changes how you select technique at the time of index fixation: use reamed nailing for closed tibial shaft fractures, where it reduces the composite complication rate. For open fractures, either technique is equivalent. Don't feel compelled to default to unreamed.
When a tibial nail patient returns at 3–4 months without clear healing, this paper is why you wait: the 6-month reoperation embargo was associated with a nonunion rate of only 4.6%, roughly half of historical figures. Patience is a treatment.
The dominant caveat: the closed fracture benefit is driven by dynamization, not by bone grafting or implant exchange. If you and your patient consider dynamization unimportant, the case for reamed nailing in closed fractures becomes less compelling. And the trial itself acknowledges it provides little evidence of superiority for the more patient-important outcomes.