Prospective RCT at a Level 1 trauma center randomizing 45 patients with displaced tibial shaft fractures (closed and Gustilo I–IIIA open) to reamed Grosse-Kempf nails vs. unreamed AO nails, with mean 3.8-year follow-up comparing time to union, nonunion, and malunion rates.
When nailing displaced tibial shaft fractures (closed or Gustilo I–IIIA open), favor reamed technique: it delivers faster union, lower dynamization burden, and no demonstrated increase in compartment syndrome or infection risk over unreamed nailing.
The theoretical advantage of unreamed nails preserving endosteal blood supply does not translate into better clinical outcomes in this population.
Prospective RCT at a Level 1 trauma center randomizing 45 patients with displaced tibial shaft fractures (closed and Gustilo I–IIIA open) to reamed Grosse-Kempf nails vs. unreamed AO nails, with mean 3.8-year follow-up comparing time to union, nonunion, and malunion rates.
When nailing displaced tibial shaft fractures (closed or Gustilo I–IIIA open), favor reamed technique: it delivers faster union, lower dynamization burden, and no demonstrated increase in compartment syndrome or infection risk over unreamed nailing.
The theoretical advantage of unreamed nails preserving endosteal blood supply does not translate into better clinical outcomes in this population.