OBJECTIVE: To determine if any differences exist in healing and complications between reamed and unreamed nailing in patients with tibial shaft fractures. DESIGN: Prospective, randomized. SETTING: Level 1 trauma center. PATIENTS: Forty-five patients with displaced closed and open Gustilo type I-IIIA fractures of the central two thirds of the tibia. INTERVENTION: Stabilization of tibial fractures either with a slotted, stainless steel reamed nail or a solid, titanium unreamed nail. MAIN OUTCOME MEASUREMENTS: Nonunions, time to fracture healing, and rate of malunions. RESULTS: The average time to fracture healing was 16.7 weeks in the reamed group and 25.7 weeks in the unreamed group. The difference was statistically significant (P = 0.004). There were three nonunions, all in the unreamed nail group. Two of these fractures healed after dynamization by removing static interlocking screws. The third nonunion did not heal despite exchange reamed nailing 2 years after the primary surgery and dynamization with a fibular osteotomy after an additional 1 year. There were two malunions in the reamed group and four malunions in the unreamed group. There were no differences for all other outcome measurements. CONCLUSION:Unreamed nailing in patients with tibial shaft fractures may be associated with higher rates of secondary operations and malunions compared with reamed nailing. The time to fracture healing was significantly longer with unreamed nails.
RCT Entities:
OBJECTIVE: To determine if any differences exist in healing and complications between reamed and unreamed nailing in patients with tibial shaft fractures. DESIGN: Prospective, randomized. SETTING: Level 1 trauma center. PATIENTS: Forty-five patients with displaced closed and open Gustilo type I-IIIA fractures of the central two thirds of the tibia. INTERVENTION: Stabilization of tibial fractures either with a slotted, stainless steel reamed nail or a solid, titanium unreamed nail. MAIN OUTCOME MEASUREMENTS: Nonunions, time to fracture healing, and rate of malunions. RESULTS: The average time to fracture healing was 16.7 weeks in the reamed group and 25.7 weeks in the unreamed group. The difference was statistically significant (P = 0.004). There were three nonunions, all in the unreamed nail group. Two of these fractures healed after dynamization by removing static interlocking screws. The third nonunion did not heal despite exchange reamed nailing 2 years after the primary surgery and dynamization with a fibular osteotomy after an additional 1 year. There were two malunions in the reamed group and four malunions in the unreamed group. There were no differences for all other outcome measurements. CONCLUSION: Unreamed nailing in patients with tibial shaft fractures may be associated with higher rates of secondary operations and malunions compared with reamed nailing. The time to fracture healing was significantly longer with unreamed nails.
Authors: Xin Sun; Diane Heels-Ansdell; Stephen D Walter; Gordon Guyatt; Sheila Sprague; Mohit Bhandari; David Sanders; Emil Schemitsch; Paul Tornetta; Marc Swiontkowski Journal: J Bone Joint Surg Am Date: 2011-02-02 Impact factor: 5.284
Authors: Carol A Lin; Marc Swiontkowski; Mohit Bhandari; Stephen D Walter; Emil H Schemitsch; David Sanders; Paul Tornetta Journal: J Orthop Trauma Date: 2016-03 Impact factor: 2.512
Authors: Justin S Yang; Jesse Otero; Christopher M McAndrew; William M Ricci; Michael J Gardner Journal: J Orthop Trauma Date: 2013-11 Impact factor: 2.512
Authors: Mohit Bhandari; Gordon Guyatt; Paul Tornetta; Emil H Schemitsch; Marc Swiontkowski; David Sanders; Stephen D Walter Journal: J Bone Joint Surg Am Date: 2008-12 Impact factor: 5.284
Authors: Byron E Chalidis; George E Petsatodis; Nick C Sachinis; Christos G Dimitriou; Anastasios G Christodoulou Journal: Strategies Trauma Limb Reconstr Date: 2009-08-25