Comparative study between reamed versus unreamed interlocking intramedullary nailing in compound fractures of shaft tibia

Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in healing of fracture. Purpose: To compare the clinical and radiological results of intramedullary interlocking nailing of open fractures of the tibial shaft after reaming versus unreamed medullary canal. Materials and Methods: Between 2008 and 2011, we have treated 40 patients with compound tibia fracture (type I, II, IIIA) by simultaneous care of wound and skeletal injury. Primary fixation for fracture stabilization was done by closed intramedullary interlock nailing either reamed or unreamed; the allocation to the two groups made on alternating basis. Wound was managed by thorough debridement with primary/delayed primary closure by suturing, split thickness skin grafting or fasciocutaneous flap cover. Active, non-weight bearing exercises were started from next post-op day. Partial weight bearing after suture removal was started on 12 th day. Further follow-up was done at 6 weeks interval for union. Results: Open fractures of shaft of tibia treated with unreamed/reamed interlocking nailing gave excellent results. In present series, 19 fractures (95%) treated by unreamed and 19 (95%) fractures treated by reamed technique, united within 6 months of injury. Delay in union was noticed in one patient treated by unreamed technique who had segmental and extensive soft tissue injury and in reamed nailing there was one patient with deep infection, which was treated with antibiotic coated nail. Conclusion: Time to complete union was similar in both groups. Adequate debridement of wound and adequate soft tissue coverage is the key to minimize deep infection irrespective of whether the bone is reamed or not.