Avoiding nonunion or delayed union and then another surgery or in worst case implant failure due to weaker construct requiring repeat mailing or other method is undesirable and this fact of early Union outweighs smaller and clinically insignificant effect of reaming. Recent works also reveal no significant bad impact of reaming.

I think each type of nails (reamed or nonreamed) has its indications. And optimal ones for each type .

the unreamed my is bet in open fractures grade one clean fractures, in fractures that are transverse mid shaft In high risk patients, or in those with fracture site minimal communication to guard Against fracture fragment displacement.

the reamed ones may be better in young people with transverse and. Short oblique fractite and stable ones

Please read my article -

Management of tibial shaft fracture .Sharma Bhanu*, Parmar R S DOI No. 10.26838/MEDRECH.2018.5.3.426

using any types of fixation methods internal or external for tibial bone, open or close fractures depend on several factors which may be include type and shape of fractures,location of the fractures ,animal species( dogs ,rabbits ,small ruminants) , age and condition ,the types of internal and external fixation methods ,cost ,the bone its self, and healing process which may be affect.so to deiced for the best methods of fixation put in your mind the specialty of tibial bone for it is not like other bones as in femoral bone fixation methods ,so any types of fixation methods have many advantages and disadvantages points ,but with your experiences and what may be done and supports you can select the suitable fixation devices .do not forget that the fixation methods what ever you select may be remain in the place for ever and this may has many disadvantages like interfere with blood circulation ,induced bone marrow defect ,bone disease ,joint stuffiness and arthritis besides the expect infection during insert or re pilling the fixation device .so to return back to the base scientific points bone fractures need some strategics plane to used materials or methods for fixation,and must be easy to use and find with less damage ,promote healing good stability not Leeds to abnormalities and anomalies,with no body rejection or complications .in may research work I use for the bone fixation for fractures healing,chemical materials intra mudalliary pinning ,bone tubular splints as a fixation methods or for space filler , or synthetics nano bone scaffolds or using shuttles pins metallic or bone synthetics from sheep or bovine bones for more stability and calcium source .

so there might be some defect and disadvantages in any types of fixation methods but the aim of your work as you must know that try to back returnee the normal function to the fractured bone quickly as you can with less risk and damage .

The mentioned two different types of tibial nails used according to the type of fractures.

For the same reason there are complications "unique" to each of these nails.

Reamed nails: These are the majority of the used nails. As mentioned already by the person putting the question forward they give more stability as they have more bone contact and so more "rigid" fixation (although it is known that the fixation provided by nails is not rigid). They provide due to the reamings, bone graft for the fracture and thus help healing. They were designed to treat closed fractures initially. This is the reason that the destruction of the intramedullary blood supply was not a problem. Despite this the majority of these nails are fluted and there are papers indication that these space are the new "blood vessels" and there helping the blood supply to the bone fragments. The complete solid round nails that were pressing the whole circumference of the bone at the intramedullary cavity are not in the market any more. Incidence of bone necrosis is limited with the reamers we use now as the RPM's are low and the reamers do not produce heat to "burn" the bone. If the fracture is segmental and the middle segment is not protected from rotation the necrosis resulting from avascularity of this segment is iatrogenic due to lack of protection by the surgeon. Bone necrosis can lead to infection, otherwise the infection must not differ from the rest of the fractures. Non comminuted closed fractures also have higher incidence of compartment syndrome as the interosseous membrane is not damaged enough. Comminuted despite the damage may result in compartment syndrome manifestation if the fracture is treated acutely and the surgeon does not allow the soft tissue swelling, result of the injury, to settle down.

Un-reamed nails: They came in the market to treat mainly open fractures. Thus the intramedullary blood supply had to be protected and their working length is from proximal locking screws to distal locking screws. They tried to replace the external fixators. An open fracture can become infected but as the wound is open and the tissues decompressed do not create the environment for compartment syndrome although in crash injuries similarities to the muscle pathology to compartment syndrome can be observed.

In conclusion, the two types of nails designed for different purpose and have different indications and they are performing well according to their indications. No further comparison can be done between them, as we possibly try to compare oranges and apples only because they are both fruits.

It is better to use unreamed nail,because reamed nail disturbs circulation .

Unreamed nails are kmown to sustain fatigue fractures if used at the wrong indication. They are not the panacea.