INTRAMEDULLARY NAILING OF TIBIAL SHAFT FR ACTURES WITH MINOR SOFT-TISSUE INJURY

The importance of intramedullary nailing (IM) for closed and type I ti bial shaft fractures is evaluated on the basis of a review of the rece nt literature (1991-1996) and the data on 61 patients that underwent a reamed (RTN; n = 31) or an unreamed (UTN; n = 26) procedure. There wa s no difference between the two groups in age, fracture type or locali zation. Soft tissue trauma prevailed with 38 % type I open fractures i n the UTN group (RTN group, 3 %). Both groups showed about the same pr oportion of good and very good results (criteria of Johner and Wruhs; 89 % RTN and 88 % UTN), which corresponds to the results of other auth ors (83 %-96 % RTN; 79 %-96 % UTN). The rate of nonunions is about the same with 6 % (RTN) and 4 % (UTN), respectively, and there were no in fections. In accordance with the literature, we found earlier osseous reunion after unreamed nailing (RTN = 18 weeks vs UTN = 12 weeks). Thi s corresponds to early, painless, full weight-bearing after an average of 10.3 as opposed to 13.8 weeks in the RTN group. Except for earlier osseous reunion reamed and unreamed TN proved to be equivalent proced ures. As a precondition, if more endostium is affected, reaming should be performed after stabilization of the soft tissue damage, and fract ures of the metaphysis should be interlocked in two dimensions (using all interlocking possibilities) if treated with the more unstable UTN, along with reduced weight-bearing for at least 6 weeks. The implant s hould be chosen in compliance with individual demands, taking the high er intramedullary stability of the RTN into consideration and the endo stium-preserving insertion of the UTN.