PROSPECTIVE-STUDY OF UNION RATE OF OPEN TIBIAL FRACTURES TREATED WITHLOCKED, UNREAMED INTRAMEDULLARY NAILS

This study was designed to verify whether open tibial fractures treate d with an unreamed tibial nail would heal without the placement of a b one graft. Twenty-nine consecutive patients treated with unreamed tibi al nails were prospectively followed to study fracture healing pattern s. Monthly radiographs were studied for signs of healing without addit ional surgical intervention until it appeared that the fracture was a delayed union or nonunion. The average patient age was 31 years (range 16-80). Twenty-seven of the fractures were open (16 grade I, 8 grade II, 3 grade IIIA), with two additional fractures with compartment synd rome open by surgical intent. All fractures resulted from high-energy trauma. Twenty-two fractures were comminuted or segmental. Fifteen fra ctures healed without secondary intervention at an average of 148 days (range 98-243). Fourteen fractures needed additional intervention fro m between 3 and 7 months postinjury, with an average intervention of 1 .9 per fracture. The two groups (primary healing and delayed union) we re similar in fracture location, mechanism, and grade of injury. Howev er, 13 of 14 delayed unions had comminuted or segmental fractures and required statically locked nails in 13 of the 14 fractures. Our experi ence suggests that the union rate is not improved with unreamed nails over that in the historical external fixator literature unless seconda ry surgical procedures are performed to change the local biology and e nhance healing. We suggest early nail dynamization and bone grafting a t 6 weeks to enhance and shorten healing time.