Treatment of open tibial fractures: Comparison between unreamed and reamed nailing A prospective randomized trial
Abstract
Objective: Treatment of open tibial fractures is an orthopedic challenge. Interlocking nailing is one of the accepted forms of treatment in these fractures. Two accepted methods of nailing are unreamed and reamed which have been largely used in closed fractures of the tibia but their use in open tibial fractures is still challenging. In this randomized clinical trial, we treated open tibial fractures using these methods and compared the results.
Methodology: Between May 2008 until September 2010 we treated 119 healthy young patients with open tibial fractures (types I, II, IIIA) by two methods of interlocking nailing. We chose the type of nailing using random table of numbers. The age of the patients was between 20 to 45 years. One hundred and six male and thirteen female patients were in two groups. Parameters including type of open fracture, length of operation, amount of blood loss during operation, superficial and deep infection, mean union time, need for dynamization and bone graft, nail and screw breakage in two respective groups were compared and the data analyzed using SPSS 13 and T-test and the P value of less than 0.05 considered as significant difference.
Results: Fifty-eight and sixty-one patients were treated in unreamed and reamed groups respectively. The time of operation was 54 minutes in unreamed and 71 minutes in reamed group with significant difference (P= 0.023). Superficial infection was seen more in reamed group in comparison with unreamed group (P=0.01) but for deep infection there was no significant difference between two groups. (P=0.31). Screw breakage was seen more in unreamed group in comparison with reamed group with significant difference (P=0.026). There was not any case of nail breakage in two groups. The time to complete union was similar in both groups.
Conclusion: Unreamed and reamed interlocking nailing can be used in open tibial fractures types I, II and IIIA with quite similar rates of success.
Methodology: Between May 2008 until September 2010 we treated 119 healthy young patients with open tibial fractures (types I, II, IIIA) by two methods of interlocking nailing. We chose the type of nailing using random table of numbers. The age of the patients was between 20 to 45 years. One hundred and six male and thirteen female patients were in two groups. Parameters including type of open fracture, length of operation, amount of blood loss during operation, superficial and deep infection, mean union time, need for dynamization and bone graft, nail and screw breakage in two respective groups were compared and the data analyzed using SPSS 13 and T-test and the P value of less than 0.05 considered as significant difference.
Results: Fifty-eight and sixty-one patients were treated in unreamed and reamed groups respectively. The time of operation was 54 minutes in unreamed and 71 minutes in reamed group with significant difference (P= 0.023). Superficial infection was seen more in reamed group in comparison with unreamed group (P=0.01) but for deep infection there was no significant difference between two groups. (P=0.31). Screw breakage was seen more in unreamed group in comparison with reamed group with significant difference (P=0.026). There was not any case of nail breakage in two groups. The time to complete union was similar in both groups.
Conclusion: Unreamed and reamed interlocking nailing can be used in open tibial fractures types I, II and IIIA with quite similar rates of success.
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