Unreamed nailing of tibial shaft fractures in multiply injured patients

In a prospective study, 63 tibial shaft fractures were managed by intramedullary nailing with a solid nail inserted without reaming. The patients were followed to union or a definitive outcome (non-union or death). Three patients died early in the post operative course as a result of other injuries. This left 60 nails in the series For complete follow up. Eighty-two per cent of the fractures were the result of motor vehicle accidents, 44 nails were inserted within 72 h of injury. Fifty-six fractures united (93%) at a mean of 21.1 weeks (8-52). There were 4 non-unions among this population of multiply injured patients. All closed fractures united at a mean of 19.5 weeks. Those nailed acutely united at a mean of 16.8 weeks. The open fracture group (classified according to Gustilo and Anderson) included the 4 non-unions (2 type II, 1 type IIIa and 1 type IIIb). A union rate of 86.2% was achieved in these fractures. All type I fractures united. One deep infection occurred in the series. The major complication identified in the current series was failure of the distal cross bolts. (C) 1996 Published by Elsevier Science Ltd.