RESULTS AFTER PRIMARY UNREAMED NAILING OF TIBIAL FRACTURES WITH SEVERE OPEN OR CLOSED SOFT-TISSUE INJURY

Primary stabilization was performed in 72 tibial fractures with severe open (n = 37) or closed (n = 35) soft tissue injury using unreamed in terlocking nails. In 60 (83%) cases the fractures healed without addit ional procedures. There were 2 cases of osteitis, but both these fract ures healed after removal of the nail or after reamed nailing. In 9 pa tients with delayed union reamed nailing (n = 8) or bone grafting (n = 1)led to healing. In 1 patient with hypertrophic pseudarthrosis, unio n was achieved after substitution of a reamed nail for the anreamed na il. The infection rate was similar to that observed with external fixa tion. More secondary procedures, such as bone grafting or a change of the osteosynthesis technique, are necessary with external fixation tha n with unreamed nailing. Further advantages of unreamed nailing are th e internal treatment of the fracture and the patient's greater comfort . Therefore, unreamed nailing can be recommended for the primary treat ment of tibial fractures with severe open or closed soft tissue trauma .