INTERLOCKING INTRAMEDULLARY NAILING WITH AND WITHOUT REAMING FOR THE TREATMENT OF CLOSED FRACTURES OF THE TIBIAL SHAFT - A PROSEPECTIVE, RANDOMIZED STUDY

One hundred and fifty-two patients mho had 154 closed fractures of the shaft of the tibia mere prospectively randomized to management with i nterlocking intramedullary nailing either with or without reaming. Thi rteen patients who had been randomized to treatment without reaming we re switched to the group that had reaming because of technical reasons ; these patients were excluded from the analysis of the results. An ad ditional five patients were lost to follow-up. Thus, seventy-two patie nts (seventy-three fractures) who had been managed with nailing with r eaming and sixty-three patients (sixty-three fractures) who had been m anaged with nailing without reaming were available for followup at an average of twelve months (range, three to thirty-three months) postope ratively. The two groups were similar with regard to demographics and the configurations of the fractures. The average total duration of the procedures performed without reaming was eleven minutes shorter than that of the procedures done with reaming (p=0.0013). The duration of f luoroscopy was not significantly different between the two groups (p=0 .35, Mann-Whitney test). The average estimated blood loss was identica l for the two groups. Seventy fractures (96 per cent) that were treate d with nailing with reaming and fifty-six (89 per cent) that were trea ted with nailing without reaming united without the need for an additi onal operation (p=0.19). Because of the small sample size, the study h as insufficient power (34.7 per cent) to detect this difference if if is real. There was only one deep infection, which developed after nail ing without reaming. The nail fractured after one procedure with reami ng. A screw fractured after two procedures with reaming and after ten without reaming (p=0.012); multiple screws fractured after three proce dures in the latter group. Malunion occurred after three nailing proce dures with reaming and after two without reaming. Four malunions were of very proximal fractures and one was of a very distal fracture. Seve nteen screws and twenty-four nails were removed after nailing with rea ming, and twenty screws and nineteen nails were removed after nailing without reaming; neither of these prevalences was significantly differ ent between the two groups (p= 0.27 and 0.89; chi-square test). We con cluded that there are no major advantages to nailing without reaming a s compared with nailing with reaming for the treatment of closed fract ures of the shaft of the tibia. There was a higher prevalence of delay ed union and breakage of screws after nailing without reaming.