Prospective RCT at a Canadian level-I trauma center randomizing 154 closed tibial shaft fractures to interlocking IMN with or without reaming, asking whether unreamed nailing — theorized to better preserve endosteal blood supply — produces equivalent or superior clinical outcomes to the established reamed technique.
For closed tibial shaft fractures requiring operative fixation, reamed IMN remains the standard: the only reproducible advantage of unreamed nailing is 11 minutes of OR time, while unreamed constructs show a trend toward higher non-union and a significantly higher rate of screw breakage.
When you see a closed tibia going to the OR, ream it — and if screws break on an unreamed nail, consider earlier dynamization rather than waiting for non-union.
Prospective RCT at a Canadian level-I trauma center randomizing 154 closed tibial shaft fractures to interlocking IMN with or without reaming, asking whether unreamed nailing — theorized to better preserve endosteal blood supply — produces equivalent or superior clinical outcomes to the established reamed technique.
For closed tibial shaft fractures requiring operative fixation, reamed IMN remains the standard: the only reproducible advantage of unreamed nailing is 11 minutes of OR time, while unreamed constructs show a trend toward higher non-union and a significantly higher rate of screw breakage.
When you see a closed tibia going to the OR, ream it — and if screws break on an unreamed nail, consider earlier dynamization rather than waiting for non-union.