A Clinical Study On Comparing The Results Of The Treatment Of Tibial Shaft Fractures Using Reamed Or Non Reamed Nails

Objective:To compare the clinical treatment effectiveness between reamed and unreamed of interlocking intramedullary nails for tibial fractures.Methods:We have carried out a retrospective review which involved 80 cases of tibial fracture patients from March 2008 to December 2009 in the Zhangzhou Chinese Medicine Hospital. All patients underwent surgery that closed reduction and internal fixation with interlocking intramedullary nail under the combined spinal and epidural anesthesia. Tibial fractures (or accompanied by fracture of fibula or femur) are closed fractures or Gustilo I,Ⅱ°open fractures. And they were devided randomly into two groups including 36 cases unreamed as the experimental group (A group) and 44 cases reamed as the control group (B group) of interlocking intramedullary nails.80 cases of patients were regularly followed up for more than 1 year.Results:The mean operative time of unreamed group and reamed group was 64 (40～120) minutes, and 70 (45～110) minutes respectively. The average blood loss was 130 (80～200) ml and 150 (90～250) ml respectively.3 cases suffered angulation deformity in unreamed group, of which 1 case reached up to 7°. And 1 case suffered angulation deformity in reamed group, which was less than 5°. No fat embolism syndrome happened.1 case suffer compartment syndrome postoperatively in unreamed group. No systemic infection happened. 2 cases suffered local infection in unreamed group, and no one in ream group. The mean fracture healing time was 116d and 102d respectively (P<0.05). The mean diameters of intramedullary nails in unreamed group and reamed group was 8.8mm and 9.4mm respectively (P<0.05). And 1 case suffered intramedullary primary nail fracture and 1 case suffered lock nail breakage in unreamed group. No nail breakage occurred in reamed group.2 cases and 1 case suffered fracture delayed union in unreamed group and reamed group respectively.1 case suffered fracture nonunion in unreamed group, and all cases were healed in unreamed group. When the last time,the fineness rate by Johner-Wruh comprehensive score was 83.33% for unreamed group and 95.45% for reamed group.Conclusion:Compared with the unreamed group, the interlocking intramedullary nails used in reamed group are more pyknic, fixed intensity higher, and the incidence rate of pin breakage is smaller. Meanwhile for the reamed group, the load time is shorter, fracture healing is more rapid, delayed union or nonunion incidence is fewer, and so on. Therefore, application of reamed of interlocking intramedullary pin for tibial fractures is better than unreamed.