Dear Panayot
I prefer unreamed intramedullary nailing because the surgical time is lower when compared with reamed since the consolidation rate is similar in the two types
Almost always reaming for a better reduction and a better stability allowing fast full weight-bearing and rehabilitation. In the end not so many compartment syndrome... Need to take care with comminuted fractures the site of which should be passed unreamed before nailing to avoid supplementary soft tissue injuries. No need either for extended medullary reaming. On my humble opinion early endo-cortical contacts with the reamer are usually sufficient and lead to a lower rate of complications. Best regards to U all...
Dear Dr.LEVI-FAICT,
My preference is close to yours.
Meanwhile, high-quality systematic reviews with meta-analysis recommend reamed IMN for closed tibial fractures, while the question if the use of reamed or unreamed nails in open tibial fractures is better than the other technique remains unresolved (s.below).
Kind regards,
Panayot Tanchev
Xia L, Zhou J, Zhang Y, Mei G, Jin D. A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures. Orthopedics. 2014, 37, 4, 332-8.
Xue D, Zheng Q, Li H, Qian S, Zhang B, Pan Z. Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials. Int Orthop. 2010 Dec;34(8):1307-13.
. Yu GS, Lin YB, Wang Y, Xu ZQ. Reamed or undreamed intramedullary nailing for tibial fractures: a meta-analysis. Chin J Traumatol. 2014, 17, 4, 229-34.
Fully agree with you... I do not have the answer as far there are contradictory results about that. Really nice question, once more!
hi doc, i alsp prefer reaming for fracture shaft tibia, else it is lower tibial or proximal shaft fractures, there are how ever some contraindications , but its not universal for all types of fractures,
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