Tibial Nailing - Steve Corbett 27/11/2001
INTRODUCTION
Important to remember that fractures may be different ie open / closed, proximal / middle / distal, comminuted etc, therefore must consider each fracture on its merits.
Considerable debate between reamed and non-reamed nails usage.
Debate centres on effects of type of nailing on healing, complications, blood flow, callus formation, free radical production etc.
PAPERS
Clinical - closed fractures
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Authors
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Court-Brown et al., (Edinburgh)
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Title
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Reamed or unreamed nailing for closed tibial fractures (Tscherne C1)
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Reference
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JBJS (Br) 1996; 78(4) : 580 -3
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Summary
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50 patients; prospective study; reamed GK nail v AO UTN nail; mean union reamed = 15 week v unreamed 22 week; 5 of unreamed group needed exchange nail; high malunion in unreamed due to implant failure especially locking screws (50%)
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Critique
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Numbers, bias, protocol including exclusion criteria and post weightbearing status may influence results
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