Reamed nailing of Gustilo grade-IIIB tibial fractures

Reamed intramedullary nailing was carried out on 57 Gustilo grade-IIIB tibi al fractures in 55 patients. After debridement, there was substantial bone loss in 28 fractures (49%), The mean time to union was 43 weeks (14 to 94), When there was no bone loss, the mean time to union was 32 weeks; it was 4 5 weeks if there was bone loss. Fractures complicated by infection took a m ean of 53 weeks to heal. Revision nailing was necessary in 13 fractures (23 %) and bone grafting in 15 (26%), In ten fractures (17.5%) infection develo ped, in four within six weeks of injury and in six more than four months la ter. Of these, nine were treated successfully, but one patient required an amputation because of osteomyelitis. Our results indicate that reamed intramedullary nailing is a satisfactory t reatment for Gustilo grade-III tibial fractures.