EFFECTIVENESS OF REAMED VS. UNREAMED INTRAMEDULLARY NAILING IN MANAGING OPEN FRACTURES OF TIBIAL SHAFT
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Keywords
Open tibial fractures, reamed intramedullary nailing, unreamed nailing, Gustilo-Anderson
Abstract
Aim: To compare the efficacy of reamed and unreamed intramedullary nailing in the management of Gustilo and Anderson Type II and IIIA open tibial shaft fractures.
Place and Duration of the Study: This study was conducted in Indus Medical College Tando Muhammad Khan from March 2024 to March 2025.
Methods: The study enrolled 113 (18-60 years old) patients who reported to the hospital within 72 hours of open tibial fracture and either had type II or IIIA open tibial fractures. Polytrauma, grossly contaminated trauma, or type I or IIIB fractures were not included. Patients were assigned to two groups: reamed (n=55) and unreamed (n=58) intramedullary nailing based upon the treatment choice or the preference of the surgeon. The outcomes included infection rates, union rates, time to union, AOFAS and VAS scores, and complication rates, including malalignment and implant failure. Data analysis was performed using SPSS 25.0 and a p-value of 0.05 was considered significant.
Results: The reamed group had lower infection rates (8.3% vs. 15.5, p=0.03), superficial (6.5 vs. 12.1, p=0.03) and deep (1.8 vs. 3.4, p=0.04) infection rates. Union rates were higher (94.5% vs. 87.9%, p=0.04), with shorter union times (19.1 ± 3.8 vs. 21.2 ± 4.5 weeks, p=0.02). AOFAS scores were superior at 6 months (87.9 ± 5.4 vs. 84.6 ± 6.3, p=0.01) and 1 year (90.5 ± 4.1 vs. 86.8 ± 5.9, p=0.02), with lower VAS pain scores (2.0 ± 1.5 vs. 3.3 ± 1.7, p=0.03 at 6 months; 1.6 ± 1.3 vs. 2.9 ± 1.6, p=0.02 at 1 year). The reamed group experienced fewer complications (3.6% vs. 8.6, p=0.04), no malalignment (0% vs.4.5%), and lower implant failure (3.6% vs. 7.0%).
Conclusion: Reamed intramedullary nailing offers better clinical and functional outcomes than unreamed nailing for Type II and IIIA open tibial fractures, supporting its use in rural settings.
References
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Abdul Samad Qureshi
Assistant Professor Orthopedic, Indus Medical College Tando Muhammad Khan Pakistan
Muhammad Hamayun Hameed
Assistant Professor Orthopedic, Bolan Medical Complex Hospital, Quetta Pakistan
Sajjad Hussain Bhatti
Assistant Professor Orthopedic, Pir Syed Abdual Qadir Shah Jillani Institute of Medical Science (GIMS) Gambat Khairpur Mir’s Pakistan
Najeeb U Rehman Kalhoro
Assistant Professor Orthopedic, Peoples University of Medical and Health Sciences Nawabshah SBA Pakistan
Hussain Bux Palh
Assistant Professor Orthopedic Surgery, Pir Syed Abdual Qadir Shah Jillani Institute of Medical Science (GIMS) Gambat Khairpur Mir’s Pakistan
Noman Khan
Senior Registrar Orthopedic, Memon Medical Institute Hospital Karachi Pakistan