Intramedullary nails may be divided into two categories: unreamed and reamed. reaming effectively lengthens the isthmus of the tibia and thereby extends the number of fractures amenable to this technique, but other studies showed that
union
impairement and infection rates were relatively high because of reaming destroyed the endosteal blood supply, especially open fractures. Unreamed interlocking nails in open fractures offer the advantage of less damage to the
intramedullary
blood supply. Also lower infection rates have been reported in open fracture when compared with reamed nails.
We analysed 22 cases of tibia shaft fractures managed with interlocking nailing without reaming and experienced treatment of complications since Septembel 1992. Average follow-up period was 13 months ranged 5 to 17 months and results
were
as
follows:
1) We used an unreamed interlocking nails for tibia open fractures, 14 cases(Gustilc-Anderson type: I . 3 cases II . 5 cases, III a 4 cases, III b. 2 cases)and closed fractures asscciated with combined injuries, 8 cases.
2) Union occurred an average of 5.2 months postoperatively with a range from three to 14 months.
3) The complications were 2 cases of superficial infection and 5 cases of nonunion(3 cases among the 8 cases of closed fracture and 2 cases among the 14 cases of open fracture.
4) The treatment of nonunion was successful with bone graft, additional screw fixation and reinsertion of reamed nail.
5) We concluded that unreamed interlocking nailing was useful method to treat the open tibial shaft fractures in the selected cases, but undesirable to treat closed tibial shaft fractures because considered less mechanical stability.
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