Rates and Odds Ratios for Complications in Closed and Open Tibial Fractures Treated With Unreamed, Small Diameter Tibial Nails: A Multicenter Analysis of 467 Cases

Abstract

Fracture distraction of more than three millimeters should not be tolerated when stabilizing tibial fractures with unreamed, small-diameter nails as this increases the odds of having a delayed union by twelve times (p < 0.001) and a nonunion by four times (p = 0.057). There was a significant increase of complications in the group of Grade III open fractures (p < 0.001), AO/OTA Type C fractures (p = 0.002), and to a lesser extent in distal fractures. However, the rate of severe complications resulting in major morbidity was low.

Critical analysis of tibial fracture healing following unreamed nailing

“…Other problems, such as early fatigue failure of nails and locking screws, were reportedly increased [9][10][11][12][13][14][15]. Unfortunately, most papers reporting the use of unreamed nailing included a small number of cases with different classification and treatment protocols making statistical evaluation difficult [15].…”

Nailing Versus Plating in the Management of Proximal Extra-Articular Tibial Fractures: A Systematic Review

“…Other techniques like supra-patellar nail insertion, nailing in semi-extended position, use of femoral distractor, and supplemental unicortical plates or external fixators were not mentioned at all. Some studies were even still using unreamed small diameter nails [22]. With the two techniques both developing with time, their shortcomings became less obvious, making both of them more acceptable, and hence the gap between them narrowed.…”

Antibiotic Intramedullary Nail in the Management of Infected Ununited Tibial Fractures - Case Report, Technique and Review of Literature

“…Tibial fractures associated with significant soft tissue damage and disrupted vascularity are at increased risk of infection, nonunion, and other associated complications [8]. Within this setting, perioperative antibiotics are thought to decrease the chance of post-operative infection, but in the presence of surgical implants such as intramedullary nails they have limited efficacy [9].…”