Review Question - QID 1299

Reamed nailing of closed tibial shaft fractures has been shown to lead to an earlier time to union without an increased rate of complications when compared to unreamed nailing.

The referenced study by Finkenmeier et al is a randomized controlled study of reamed vs. unreamed nails in open and closed tibia fractures (excluding Grades IIIB and IIIC). They found that the use of reamed insertion of IM nails for the treatment of closed tibia fractures lead to an earlier time to union without increased complications. The authors reported no differences in infection rate, compartment syndrome rate, or percent needing additional surgeries to obtain union. More secondary procedures were needed with unreamed nails in closed fractures only. Increased rates of interlocking screw failure were seen if smaller screws were needed for smaller, unreamed nails.

The referenced study by Keating et al reported that reaming for open tibia fractures is safe, with time to union and nonunion rate increasing with increased soft tissue injury as classified by the Gustilo-Anderson classification.

Bhandari et al conducted a multicenter, blinded randomized trial of 1319 adults in whom a tibial shaft fracture was treated with either reamed or unreamed intramedullary nailing. When comparing outcomes in open and closed injuries at twelve months, they found a benefit for reamed intramedullary nailing in patients with closed fractures, but found no difference between approaches in patients with open fractures.

Figure A shows a tibial shaft fracture, with intramedullary fixation shown in Figures B and C.