Comparison of reamed and nonreamed solid core nailing of the tibial diaphysis after external fixation: a preliminary report.

From July 1982 to March 1990, 32 patients had an external fixator applied to treat a tibial diaphyseal fracture and subsequently underwent intramedullary nailing: 16 with reamed and 16 with nonreamed solid core nails. Indications for surgery were 12 atrophic and 1 hypertrophic nonunion in each group. The balance were either planned conversions or inadequate external fixators due to head injuries. All but one were seen by an author at a minimum of 1 year. Among the reamed nails, 3 fractures were grade III B. Two patients had pin tract infections, and there were no prenail wound infections. All infections were clinically inactive at the time of nail insertion. Postnail, 7 patients became infected, requiring 12 debridements and 2 procedures to achieve union. One patient had a plate applied 44 weeks postnail and was lost 48 weeks postnail with a persistent infected nonunion. The average time to union was 26 weeks. In the nonreamed solid core group, 2 fractures were grade III A and 5 grade III B. There were 2 pin and 5 prenail wound infections. One nail was inserted across an active pin tract infection. One tibia became infected postnail (p = .04). The fractures united at an average of 14 weeks postnail (p = .036). Two debridements to control infection but no further procedures to achieve union were necessary (p = .003). When tibial reconstructions following external fixation are required, nonreamed solid core nails are efficacious and may be preferable to reamed nails.