Systematic review shows lowered risk of nonunion after reamed nailing in patients with closed tibial shaft fractures

Lam, S.W.; Teraa, M.; Leenen, L.P.H.; van der Heijden, G.J.M.G.

doi:10.1016/j.injury.2010.02.020

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Volume 41, Issue 7 , Pages 671-675, July 2010

Systematic review shows lowered risk of nonunion after reamed nailing in patients with closed tibial shaft fractures

S.W. Lam
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
- These authors contributed equally to this work.
- Corresponding author at: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum Building 6.131, PO Box 85.500, 3508 GA Utrecht, The Netherlands. Tel.: +31 88 755 9377; fax: +31 88 755 5485.
M. Teraa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
- These authors contributed equally to this work.
L.P.H. Leenen
- Department of Traumatology, University Medical Center Utrecht, The Netherlands
G.J.M.G. van der Heijden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands

Accepted 15 February 2010.

Abstract

Nonunion after intramedullary nailing (IMN) in patients with tibial shaft fractures occurs up to 16%. There is no agreement whether reaming prior to IMN insertion would reduce the nonunion rate. We aimed to compare the nonunion rate between reamed and unreamed IMN in patients with tibial shaft fractures.

A systematic search was conducted in Pubmed, Embase, and the Cochrane Library. The selected publications were: (1) randomised controlled trials; (2) comparing the nonunion rate; (3) in patients with tibial shaft fractures; (4) treated with either reamed or unreamed IMN.

Seven studies that satisfied the criteria were identified. They showed that reamed IMN led to reduction of nonunion rate compared to unreamed IMN in closed tibial shaft fractures (risk difference ranging 7.0–20%, number needed to treat ranging 5–14), while the difference between compared treatments for open tibial shaft fractures was not clinically relevant.

The evidence showed a consistent trend of reduced nonunion rate in closed tibial shaft fracture treated with reamed compared to unreamed IMN.

Keywords: Tibial shaft fractures, Tibia, Intramedullary nailing, IMN, Nail, Reaming, Unream, Nonunion