Surgical management of open tibial shaft fractures in adults by reamed versus unreamed intramedullary interlocking nailing: A comparative study

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Back ground and objectives: Tibial diaphyseal fractures are one of the commonest long bone fractures encountered by most of the orthopaedic surgeons. Because most of the length of tibia is subcutaneous throughout, open fractures are more common in tibia than in any other major long bone. Because of high prevalence of complications associated with these fractures, management is often is difficult and the optimum method of treatment remains a subject of controversy. This prospective study was conducted at the department of orthopaedics, KIMS Hubli to evaluate and compare the results of closed interlocking intramedullary nailing with and without reaming in the treatment of the open fractures of mid shaft tibia in adults. It was done to compare the efficiency of interlocking intramedullary nailing with and without reaming in treatment of open fractures of mid shaft tibia with other studies in terms of time required for union, rate of malunion and malrotation, rate of infection and range of motion of ankle and knee joint.Materials and methods: This study was done on 50 patients between the age group of 25-40yrs admitted under Department of Orthopaedics of Karnataka Institute of Medical Sciences Hospital, Hubli with open fractures mid shaft of tibia selected based on inclusion & exclusion criteria during the period from 1/08/2013 to 31/07/2015 treated surgically using reamed/unreamed intramedullary interlocking nailing. Of the 50 patients 25 were treated by reamed and 25 by unreamed intramedullary interlocking nailing. All the cases were fresh fractures and traumatic in nature. They were done with the procedure as early as possible and the secondary procedures were done when needed. The cases were followed up for an average period of 6-9 months. None of the cases were lost to follow up. Results: Open fractures of the tibial shaft managed with or without reamed interlocked intramedullary nailing gave good functional results and patient satisfaction It involves minimal surgical trauma and less blood loss. It provides the advantages of early ambulation, lower rates of infection, delayed union, non union and malunion compared to other treatment modalities. It provides with early weight bearing and earlier returns to work. In our series, the overall functional outcome according to Johner and Wruhs’ criteria is equal and there is no significant difference in both reamed and unreamed nailing in open tibial shaft fractures in adults. Interpretation and conclusions: Intramedullary nailing is one of the methods of treatment for open tibial shaft fractures in adults, despite the fact that controversy exists regarding the choice of reamed or unreamed intramedullary nailing. There are no clear indications or contraindications for choosing either option. Clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft. The over-all functional outcome according to the Johner and Wruhs’ criteria was similar between the two groups, with no evidence that reaming delays the process of union. Considering the ease of performing the technique and the decreased operative time, unreamed interlocking nailing may have an edge over reamed interlocking nailing.