• OBJECTIVES
    • We sought to determine the effect of reaming on 1-year 36-item short-form general health survey (SF-36) and short musculoskeletal function assessment (SMFA) scores from the Study to Prospectively Evaluate Reamed Intramedullary Nails in patients with Tibial Fractures.
  • DESIGN
    • Prospective randomized controlled trial.1319 patients were randomized to reamed or unreamed nails. Fractures were categorized as open or closed.
  • SETTING
    • Twenty-nine academic and community health centers across the US, Canada, and the Netherlands.
  • PATIENTS/PARTICIPANTS
    • One thousand three hundred and nineteen skeletally mature patients with closed and open diaphyseal tibia fractures.
  • INTERVENTION
    • Reamed versus unreamed tibial nails.
  • MAIN OUTCOME MEASUREMENTS
    • SF-36 and the SMFA. Outcomes were obtained during the initial hospitalization to reflect preinjury status, and again at the 2-week, 3-month, 6-month, and 1-year follow-up. Repeated measures analyses were performed with P < 0.05 considered significant.
  • RESULTS
    • There were no differences between the reamed and unreamed groups at 12 months for either the SF-36 physical component score [42.9 vs. 43.4, P = 0.54, 95% Confidence Interval for the difference (CI) -2.1 to 1.1] or the SMFA dysfunction index (18.0 vs. 17.6, P = 0.79. 95% CI, -2.2 to 2.9). At one year, functional outcomes were significantly below baseline for the SF-36 physical componentf score, SMFA dysfunction index, and SMFA bothersome index (P < 0.001). Time and fracture type were significantly associated with functional outcome.
  • CONCLUSIONS
    • Reaming does not affect functional outcomes after intramedullary nailing for tibial shaft fractures. Patients with open fractures have worse functional outcomes than those with a closed injury. Patients do not reach their baseline function by 1 year after surgery.
  • LEVEL OF EVIDENCE
    • Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.