A COMPARISON OF REAMED AND UNREAMED NAILING OF THE TIBIA

The availability of unreamed interlocked nails for fixation of tibia f ractures has raised the issue of what effect reaming the intramedullar y canal has on the clinical outcome after tibial nailing. A retrospect ive review was performed of all tibial fractures treated with interloc king nailing at the authors' institution over the past 5 years in orde r to compare reamed and unreamed nailing. Forty-five nailings were ide ntified of which 38 had adequate follow-up information to be considere d healed or non-united at 1 year. Thirteen reamed and 23 unreamed tibi al nailings were followed to healing; there were 6 nonunions. The unre amed nailings had lower average operative times and lower average esti mated blood loss, although the results did not reach statistically sig nificant levels. There was a statistically significant difference in h ealing times, with unreamed nailings taking an average of 242 days to heal while reamed nailings took 158. This difference held for subgroup s such as isolated tibia fractures, closed tibial fractures, and high- energy tibial fractures. Six nonunions occurred, one in a reamed naili ng and five in unreamed nailings. Malunions occurred in four reamed na ilings and six unreamed nailings, most often in distal third fractures , interlocked on only one side of the fracture. Patellofemoral complic ations were more common in unreamed nailings. Although this study is l imited by retrospective, nonrandom design, it raises questions about t he routine use of unreamed nailing with regard to healing potential an d other postoperative complications. Further study is warranted.