152 patients who had 154 closed fractures of the shaft of the tibia were prospectively randomized to management with interlocking intramedullary nailing either with or without reaming. 13 patients who had been randomized to treatment without reaming were switched to the group that had reaming because of technical reasons; these patients were excluded from the analysis of the results. An additional 5 patients were lost to follow-up. Thus, 72 patients (73 fractures) who had been managed with nailing with reaming and 63 patients (63 fractures) who had been managed with nailing without reaming were available for follow-up at an average of 12 months (range, 3 to 33 months) postoperatively. The 2 groups were similar with regard to demographics and the configurations of the fractures. The average total duration of the procedures performed without reaming was 11 minutes shorter than that of the procedures done with reaming (p = 0.0013). The duration of fluoroscopy was not significantly different between the 2 groups (p = 0.35, Mann-Whitney test). The average estimated blood loss was identical for the 2 groups. 70 fractures (96 per cent) that were treated with nailing with reaming and 56 (89 per cent) that were treated with nailing without reaming united without the need for an additional operation (p = 0.19). Because of the small sample size, the study has insufficient power (34.7 per cent) to detect this difference if it is real. There was only one deep infection, which developed after nailing without reaming. The nail fractured after one procedure with reaming. A screw fractured after 2 procedures with reaming and after 10 without reaming (p = 0.012); multiple screws fractured after 3 procedures in the latter group. Malunion occurred after 3 nailing procedures with reaming and after 2 without reaming. 4 malunions were of very proximal fractures and one was of a very distal fracture. 17 screws and 24 nails were removed after nailing with reaming, and 20 screws and 19 nails were removed after nailing without reaming; neither of these prevalences was significantly different between the 2 groups (p = 0.27 and 0.89; chi-square test). We concluded that there are no major advantages to nailing without reaming as compared with nailing with reaming for the treatment of closed fractures of the shaft of the tibia. There was a higher prevalence of delayed union and breakage of screws after nailing without reaming.
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152 patients who had 154 closed fractures of the shaft of the tibia were prospectively randomized to management with interlocking intramedullary nailing either with or without reaming. 13 patients who had been randomized to treatment without reaming were switched to the group that had reaming because of technical reasons; these patients were excluded from the analysis of the results. An additional 5 patients were lost to follow-up. Thus, 72 patients (73 fractures) who had been managed with nailing with reaming and 63 patients (63 fractures) who had been managed with nailing without reaming were available for follow-up at an average of 12 months (range, 3 to 33 months) postoperatively. The 2 groups were similar with regard to demographics and the configurations of the fractures. The average total duration of the procedures performed without reaming was 11 minutes shorter than that of the procedures done with reaming (p = 0.0013). The duration of fluoroscopy was not significantly different between the 2 groups (p = 0.35, Mann-Whitney test). The average estimated blood loss was identical for the 2 groups. 70 fractures (96 per cent) that were treated with nailing with reaming and 56 (89 per cent) that were treated with nailing without reaming united without the need for an additional operation (p = 0.19). Because of the small sample size, the study has insufficient power (34.7 per cent) to detect this difference if it is real. There was only one deep infection, which developed after nailing without reaming. The nail fractured after one procedure with reaming. A screw fractured after 2 procedures with reaming and after 10 without reaming (p = 0.012); multiple screws fractured after 3 procedures in the latter group. Malunion occurred after 3 nailing procedures with reaming and after 2 without reaming. 4 malunions were of very proximal fractures and one was of a very distal fracture. 17 screws and 24 nails were removed after nailing with reaming, and 20 screws and 19 nails were removed after nailing without reaming; neither of these prevalences was significantly different between the 2 groups (p = 0.27 and 0.89; chi-square test). We concluded that there are no major advantages to nailing without reaming as compared with nailing with reaming for the treatment of closed fractures of the shaft of the tibia. There was a higher prevalence of delayed union and breakage of screws after nailing without reaming.
Copyright remains with the authors and publisher.