The treatment of closed, unstable tibial shaft fractures with unreamed interlocking nails.

Forty-seven closed, unstable tibial shaft fractures were treated with locked intramedullary nailing without reaming at the authors' institution. Fifty-three percent of the fractures were in polytraumatized patients. Followup was possible for 38 (81%) fractures. Thirty-three fractures healed within 6 months (87%). All patients had unlimited ambulation without assistive devices, and the ability to climb stairs in a normal fashion. Range of motion of the knee, ankle, and subtalar joints at final followup was normal, except in those patients who had concomitant joint injuries. There were 2 delayed unions (5%) and 3 nonunions (8%). Three patients had angular deformities. There were no broken nails in this series (0%), but 12 of 80 screws were bent or broken. There was 1 (2.6%) superficial infection, and 1 (2.6%) case of osteomyelitis. Interlocked, intramedullary nailing inserted in an unreamed manner has become the treatment of choice for the closed, unstable tibial shaft fracture in the polytraumatized patient in the authors' institution. A high union rate, coupled with a lack of compartment syndromes or peroneal palsy, makes this procedure an attractive alternative to reamed nailing. This study was not able to prove any superiority over reamed nail insertion in closed, isolated, unstable tibial shaft fractures.