Analysis of Complications after Nailing of Tibia Shaft Fractures

PURPOSE: The occurence of complications after reamed and unreamed nailing of the tibia shaft should be analyzed to raise the awareness of quality and of occuring complications. In addition our own results should be compared to international studies in order to be able to recommend a better recommendation of treatment. MATERIAL AND METHODS: In between January 1995 and December 2001 110 patients suffering from tibia shaft fractures (67 male, 43 female, average age 40.7 years) were treated with tibia nailing. In 94 cases (85.5 %) initially an unreamed nail, in 16 cases (14.5 %) a reamed nail was used. 55 cases (50.0 %) primarily with severe soft tissue damage were initially treated with external fixation. In these cases after an average of 10.9 days an intramedullary nailing followed. Primary additional procedures occured in 46 cases (41.8 %). In 2004 a follow-up examination based on the criteria of Merchant and Dietz (1989) was performed on 88 patients (80.0 %) with radiologically proved bony fracture consolidation. In order to prove if there is a statistically significant correlation between the applied nailing procedure and an occured complication a Pearson Chi-square test was used. RESULTS: A complication occured in 21 cases (complication rate 19.1 %). The complication rate in the unreamed group was 20.2 % (19 cases), in the reamed group 12.5 % (2 cases). In 21 cases with a complication (19.1 %) secondary interventions were necessary and in all cases healing was achieved by bony consolidation. In our study the Pearson Chi-square test showed no significant correlation between the used nailing procedure and the occurence of a certain complication (p = 0.229). CONCLUSION: At primary reamed nailing the complication rate concerning fracture healing disturbances can be essentially reduced by correct setting of indication. In our study there is a tendency of higher pseudarthrosis rates after unreamed nailing. Reamed nailing should not be used in every case of tibia shaft fractures. Deciding between unreamed and reamed nailing requires constant consideration of advantages and disadvantages of each procedure and reconciliation with the individual character of each case.