A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft.

摘要: Objectives: To determine if there are differences in healing, complications, or number of procedures required to obtain union among open and closed tibia fractures treated with intramedullary (IM) nails inserted without reaming. Design: Prospective, surgeon-randomized comparative study. Setting: Level One trauma center. Patients: Ninety-four consecutive patients unstable (excluding Gustilo Grade IIIB IIIC) the tibial shaft IM nail insertion between November 1, 1994, June 30, 1997. Intervention: Interlocked medullary canal Main Outcome Measures: Time union, type incidence secondary performed union. Results: For fractures, were no significant time additional per formed reamed compared those insertion. A higher percentage healed at four months after unreamed (p = 0.040), but was not a difference six twelve months. More needed for treatment frac tures, statistically given limited power our study 0.155). Broken screws seen only smaller-diameter reaming, majority occurred who noncompliant weight-bearing restrictions. There rates infection compartment syndrome. Conclusion: Our findings support use which led earlier increased complications. In addition. reaming did increase risk complications fractures.