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.