Reaming Does Not Affect Functional Outcomes After Open and Closed Tibial Shaft Fractures

Abstract

Objectives We sought to determine the effect of reaming on 1-year SF-36 and SMFA scores from the Study to Prospectively Evaluate Reamed Intramedullary Nails in patients with Tibial Fractures (SPRINT). Design Prospective randomized controlled trial. 1,319 patients were randomized to reamed or unreamed nails. Fractures were categorized as open or closed. Setting 29 academic and community health centers across the US, Canada, and the Netherlands Patients/Participants 1,319 skeletally mature patients with closed and open diaphyseal tibia fractures. Intervention Reamed versus unreamed tibial nails Main Outcome Measurements SF-36 and the SMFA. Outcomes were obtained during the initial hospitalization to reflect preinjury status, and again at the 2-week, 3-month, 6-month, and 1-year follow-up. Repeated measures analyses were performed with P <0.05 considered significant. Results There were no differences between the reamed and unreamed groups at 12 months for either the SF-36 Physical Component Score (PCS) (42.9 v 43.4, p = 0.54, 95% Confidence Interval for the difference [CI] −2.1 to 1.1) or the SMFA Dysfunction Index (DI) (18.0 v 17.6, p=0.79. 95% CI −2.2 to 2.9). At one year, functional outcomes were significantly below baseline for the SF-36 PCS, SMFA DI, and SMFA Bothersome Index (p < 0.001). Time and fracture type were significantly associated with functional outcome. Conclusions Reaming does not affect functional outcomes following intramedullary nailing for tibial shaft fractures. Patients with open fractures have worse functional outcomes than those with a closed injury. Patients do not reach their baseline function by one year after surgery.

Prognostic factors for predicting health-related quality of life after intramedullary nailing of tibial fractures: a randomized controlled trial

“…For the SMFA Bother, significant predictors of function were time from injury to follow-up assessment and open versus closed. 32 The main effect of reamed versus unreamed nailing was not a significant predictor in any of the functional subcategories. 32 …”

“…In a previous publication using data from the SPRINT trial, a mixed model repeated measures analysis was conducted by Lin et al 32 for the entire cohort to determine factors associated with HRQoL. They found that significant predictors of the SF-36 PCS were time from injury to follow-up assessment, open versus closed fracture, open versus closed by time from injury to follow-up assessment interaction, and treatment by time from injury to follow-up assessment interaction.…”

Modern treatment of tibial shaft fractures: Is there a role today for closed treatment?

“…Tibial shaft fractures are common injuries and can be sustained via both high and low energy mechanisms in patients of all ages 1 . In skeletally mature patients with displaced tibial shaft fracture, the most common treatment is intramedullary nail fixation 2 , 3 , as operative treatment allows earlier definitive stabilization, avoids prolonged cast/brace treatment, and may allow for more rapid mobilization as well as faster time to union 4 .…”

Study protocol: design and rationale for an exploratory phase II randomized controlled trial to determine optimal vitamin D3 supplementation strategies for acute fracture healing

“…Numerous negative consequences of lower extremity long bone fractures have been documented, including delayed healing, nonunion, malunion, and significantly delayed functional recovery [1, 2]. Specifically, at 1-year post-injury, most lower extremity long bone fracture patients have not regained their pre-injury function or quality of life [3–6]. Decreasing re-operations, improving fracture healing, and hastening functional recovery remain ongoing priorities for the orthopedic community.…”