Abstract
Tibial fractures were the most common long bone fracture. These were treated by intramedullary nailing. Treatment of reamed versus unreamed intramedullary nailing was still controversial. This comparative study was conducted in the department of orthopaedic surgery in Mahatma Gandhi Memorial Hospital, Warangal, Telangana state, India with an aim to know the efficacy of both treatments. In this study the average duration of surgery was 72±12 min, the average time to full weight-bearing was 9.2 weeks and the average time to union of the fracture was 14 weeks. The unreamed intramedullary nailing group demonstrated a significantly higher rate of fracture non-union (R 3%, U 6%) and malunion (R 6%, U 9%). The significantly higher incidences of implant exchange, a higher risk of screw failure and dynamization were noticed in the unreamed intramedullary nailing group. Regarding the adverse effects like infection, compartment syndrome and knee pain there was no significant difference between two groups.
Highlights
Fractures of long bones constitute the majority of emergency operating room procedures in most trauma centers
Reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures- A comparative study
The significantly higher incidences of implant exchange, a higher risk of screw failure and dynamization were noticed in the unreamed intramedullary nailing group
Summary
Fractures of long bones constitute the majority of emergency operating room procedures in most trauma centers. Fractures of the tibial shaft have a recorded incidence of 17 to 21 per 100,000 population, representing 2% of all fractures and 36.7% of all long bone fractures in adults [1,2]. The publications of Kuntscher[3] opened the era of modern intramedullary nailing with metallic nails. This technique has been reported as highly successful in terms of fast union, good alignment, low shortening, good functional results, and low complication rates [4]. The choice between reamed or unreamed intramedullary nailing of tibial fractures remains controversial. Unreamed nailing preserves the endosteal blood supply and may improve fracture-healing and decrease the risk of infection. Reamed nailing with use of larger nails, while destructive to the endosteal blood supply, affords greater stability [5]
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