Clinical Experience with Reamed Intramedullary Nails for Open Tibial Fractures

Abstract

Forty-four open tibialfractures were treated with reamed intramedullary-nailing at our hospital from May 1987 to April 1994. These were followed for an average of 20 months. Most of the fractures were the result of a high-energy injury due to a motorcycle accident. There were 34 open type I fractures and 10 open type II fractures. Forty-three of the 44 fractures united at an average of 4.5 months (range 3 to 8 months). The movement of knee and ankle were satisfactory. There were 2 deep infections (4.5 per cent), including one infected nonunion, The microorgan-isms of the infection were Staphylococcus aureus and Pseudomonas aeruginosa respectively. Mild varus angulation was noted in 3 tibiae, but no patient had a complaint. Malposition of the nail which needed a revision was noted in one case. Most of the complications were due to technical errors and avoidable. The results were comparable with those treatment with other forms of fixa-tion, including undreamed intramedullary nail or external fixation. Reamed intramedullary nailing did not jeopardize the fracture union nor increase the incidence of deep infection provided the periosteum was intact. Reaming the tib-ial canal and applying a large nail could provide greater stability which decreased the incidence of nail failure. For unstable comminuted fractures, stat-ic interlocing nails provided better results; and the complications, especially varus angulation, were avoidable. Bonegrafting was rarely necessary for reamed intramedullary nailing of open tibial fracture in the absence of large bone defects. We believe that reamed intramedullary nailing is safe and effect-tive method for the treatment ofopen type I and II tibial fractures.

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