Tibial shaft fractures treated with the AO unreamed tibial nail

A Prospective Comparative Study of Reamed vs. Unreamed Nailing in Fractures Shaft of Tibia

ABSTRACT

BACKGROUND

Although the tibia is one of the most commonly fractured long bones in the body, there are two accepted management techniques: reamed and unreamed nailing. There is not a general consensus as to which technique is more advantageous to the patient.

PATIENTS AND METHODS

This was a single centre prospective randomized trial of 38 adults with a tibial shaft fracture who were treated with either reamed or unreamed nailing.

RESULTS

Overall fracture healing time was 23 weeks in the reamed group and 25 weeks in the unreamed group. Differences in rate of clinical union, clinical outcome, time for weight bearing and complications in both the groups were not statistically significant.

CONCLUSION

There are no clear indications or contraindications to favour either reamed or unreamed nailing over the other. Technique, fracture union, functional outcome and complications are similar in both groups. Considering the ease of technique application and the decreased operative time, unreamed interlocking nailing has an edge over reamed interlocking nailing.

KEY WORDS

Reamed, unreamed, interlocking nailing, fracture shaft of tibia.

Fatigue behavior of Ilizarov frame versus tibial interlocking nail in a comminuted tibial fracture model: a biomechanical study

Background

Treatment options for comminuted tibial shaft fractures include plating, intramedullary nailing, and external fixation. No biomechanical comparison between an interlocking tibia nail with external fixation by an Ilizarov frame has been reported to date. In the present study, we compared the fatigue behaviour of Ilizarov frames to interlocking intramedullary nails in a comminuted tibial fracture model under a combined loading of axial compression, bending and torsion. Our goal was to determine the biomechanical characteristics, stability and durability for each device over a clinically relevant three month testing period. The study hypothesis was that differences in the mechanical properties may account for differing clinical results and provide information applicable to clinical decision making for comminuted tibia shaft fractures.

Methods

In this biomechanical study, 12 composite tibial bone models with a comminuted fracture and a 25 mm diaphyseal gap were investigated. Of these, six models were stabilized with a 180-mm four-ring Ilizarov frame, and six models were minimally reamed and stabilized with a 10 mm statically locked Russell-Taylor Delta™ tibial nail. After measuring the pre-fatigue axial compression bending and torsion stiffness, each model was loaded under a sinusoidal cyclic combined loading of axial compression (2.8/28 lbf; 12.46/124.6 N) and torque (1.7/17 lbf-in; 0.19/1.92 Nm) at a frequency of 3 Hz. The test was performed until failure (implant breakage or ≥ 5° angulations and/or 2 cm shortening) occurred or until 252,000 cycles were completed, which corresponds to approximately three months testing period.

Results

In all 12 models, both the Ilizarov frame and the interlocking tibia nail were able to maintain fracture stability of the tibial defect and to complete the full 252,000 cycles during the entire study period of three months. A significantly higher stiffness to axial compression and torsion was demonstrated by the tibial interlocking nail model, while the Ilizarov frame provided a significantly increased range of axial micromotion.

Conclusion

This is the first study, to our knowledge, which compares the biomechanical properties of an intramedullary nail to an external Ilizarov frame to cyclic axial loading and torsion in a comminuted tibia shaft fracture model. Prospective, randomized trials comparing Ilizarov frames and interlocked tibial nails are needed to clarify the clinical impact of these biomechanical findings.