A Meta-analysis of Reamed Versus Unreamed Intramedullary Nailing for the Treatment of Closed Tibial Fractures

Abstract

Controversy exists regarding the clinical outcomes of reamed vs unreamed intramedullary nailing in the treatment of closed tibial fractures. This study assessed the effects of reamed vs unreamed intramedullary nailing for closed tibial fractures. The authors searched PubMed, EMBASE, BIOSIS, and the Cochrane Controlled Trials Register for randomized and quasi-randomized controlled clinical trials from January 1980 to June 2012 comparing reamed with unreamed intramedullary nailing for closed tibial fracture in adults. Primary outcomes were nonunion, delayed union, malunion, secondary procedure, failure of implants, compartment syndrome, infection, and knee pain. Eight randomized and 1 quasi-randomized clinical trials (1229 fractures) were included. No statistically significant differences were found between reamed and unreamed nailing groups in delayed union (P=.20), malunion (P=.28), infection (P=.36), compartment syndrome (P=.36), and knee pain (P=.93). The unreamed group had a higher rate of fracture nonunion than the reamed group (P=.02). The subgroup analysis of implant failures (broken screws vs broken nails) indicated that reamed nailing significantly reduced the risk of screw breakage (P<.001); however, there was no significant difference between reamed and unreamed intramedullary nailing in nail breakage (P=.94). The subgroup analysis of a secondary procedure showed that the reamed intramedullary nailing resulted in significantly lower risks of implant exchange (P=.01) and dynamization (P=.04); however, there was no significant difference in bone grafting rate (P=.73). Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risks of nonunion, screw failure, implant exchange, and dynamization without increasing operative complications.

Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion

“…Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risk for nonunion, screw failure, implant exchange, and dynamization without increasing operative complications [21,25], whereas the choice for open tibial fractures remains uncertain [26].…”

Determinants of re-operation following tibia intramedullary nailing at a tertiary hospital in south-west Nigeria

“…In our series, all the patients had reamed intramedullary nailing for both open and closed tibia fractures. Reamed intramedullary nailing is a preferred choice because of reported advantages of providing optimal mechanical stability, rapid fracture union and low incidence of secondary procedure [6–10]. Some authors have found that the rate of nonunion following open tibia fracture that will necessitate re-operation varies from 4%-48% [4].…”

Is There an Impact of Concomitant Injuries and Timing of Fixation of Major Fractures on Fracture Healing? A Focused Review of Clinical and Experimental Evidence

“…Furthermore, the reaming products themselves have been shown to comprise osteoblasts and multipotent stem cells and tend to therefore act as potent bone grafts. 58,59 Experimental Studies Study characteristics of the cited studies are demonstrated in Tables 3 and 4. Experimental studies allow for better standardization to assess fracture healing under conditions different than the clinical setting.…”