Reamed Or Unreamed Nailing? --A Clinical Study On The Intramedullary Nailing On Tibail Fractures

The intramedullary nailing in the treatment of tibial shaft fractures is commonly used now[1-4]. Some authors[5-8] prefer nonreamed nailing in order to minimize the injury and to protect the blood flow of the endosteum. It could also prevent delayed union and nonunion and the possibility of fat embolism syndrome. Up to now several studies show that the reamed nailing not only could promote the fracture union but also may decrease the incidence of complication[9-11]. The author try to observe the changes of the deep posterior compartment pressures both during reamed and nonreanied nailing and to evaluate the influence on the edema of the extremeties. At the same time the author had proceeded a prospective clinical study to show which is the better method of the treatment between the reamed and nonreamed nailing. 1 jo observe the changes of the deep posterior compartment pressure (DPCP) during the reamed and nonreamed nailing. The compartment pressure will be elevated not only because of the soft tissue injury or tibial shaft fracture but also during the closed reduction, nailing and reaming[12-13] But it does not increase to a level so as to cause the compartment syndrome indeed~?~. To observe changes of the compartment pressures between the reamed and nonreamed nailing, the DPCP were monitored in 33 cases of tibial shaft fracture. There were 17 reamed and 16 nonreamed cases. The pressures were recorded at times on postanesthesia, reduction by traction, prenailing, nailing, after locking of nail and postoperation. In the reamed group, this was also done during insertion of guide wire and reaming. The pressure was also monitored on the contralateral leg after the anesthesia and after the operation. The results showed that the pressure on the wounded side was higher than the -J unwounded side with a statistical difference(J)