16819
document
Should insertion of intramedullary nails for tibial fractures be with or without reaming ? A prospective , randomized study with 3.8 years ' follow-up . OBJECTIVE To determine if any differences exist in healing and complications between reamed and unreamed nailing in patients with tibial shaft fractures . DESIGN Prospective , randomized . SETTING Level 1 trauma center . PATIENTS Forty-five patients with displaced closed and open Gustilo type I-IIIA fractures of the central two thirds of the tibia . INTERVENTION Stabilization of tibial fractures either with a slotted , stainless steel reamed nail or a solid , titanium unreamed nail . MAIN OUTCOME MEASUREMENTS Nonunions , time to fracture healing , and rate of malunions . RESULTS The average time to fracture healing was 16.7 weeks in the reamed group and 25.7 weeks in the unreamed group . The difference was statistically significant ( P = 0.004 ) . There were three nonunions , all in the unreamed nail group . Two of these fractures healed after dynamization by removing static interlocking screws . The third nonunion did not heal despite exchange reamed nailing 2 years after the primary surgery and dynamization with a fibular osteotomy after an additional 1 year . There were two malunions in the reamed group and four malunions in the unreamed group . There were no differences for all other outcome measurements . CONCLUSION Unreamed nailing in patients with tibial shaft fractures may be associated with higher rates of secondary operations and malunions compared with reamed nailing . The time to fracture healing was significantly longer with unreamed nails .
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Intervention_Surgical
reamed and unreamed nailing
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Intervention_Surgical
Stabilization of tibial fractures either with a slotted , stainless steel reamed nail or a solid , titanium unreamed nail .
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Intervention_Surgical
reamed
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Intervention_Surgical
unreamed
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Intervention_Surgical
unreamed nail
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Intervention_Surgical
reamed
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Intervention_Surgical
reamed nailing .
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Outcome_Physical
Nonunions
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Outcome_Other
time to fracture healing , and rate of malunions
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Outcome_Other
average time to fracture healing
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Outcome_Physical
nonunions
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Outcome_Physical
healed after dynamization by removing static interlocking screws
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Outcome_Physical
heal
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Outcome_Physical
malunions
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Outcome_Physical
malunions
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Outcome_Other
rates of secondary operations and malunions
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Outcome_Other
time to fracture healing
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Participant_Condition
tibial