Reamed Versus Unreamed Intramedullary Interlocking Nail for Gustilo and Anderson Type II and IIIA in Open Fractures of Shaft of Tibia

Open fractures of the tibial shaft, particularly Gustilo and Anderson Type II and IIIA fractures, present a unique and challenging scenario in orthopedic trauma care. Objectives: To compare the outcomes of reamed versus unreamed intramedullary nailing in the management of Gustilo and Anderson Type II and IIIA open tibial shaft fractures. Methods: This prospective cohort study study was conducted at Gajju Khan Medical College/ Bacha Khan Medical Complex, Swabi from May 2023 to December 2023. Data were collected from 129 patients. All surgeries were performed under general or spinal anesthesia by experienced orthopedic trauma surgeons. The standard anterolateral approach was used for tibial nailing. Results: 129 patients were enrolled in the study, with 64 patients in the reamed group and 65 patients in the unreamed group. The mean age of patients in the reamed group was 36.4 ± 9.2 years, and in the unreamed group, it was 37.2 ± 8.7 years. The mechanisms of injury were also comparable, with both groups experiencing similar proportions of motor vehicle accidents (58%), falls from height (34%), and industrial accidents (8%), with p-values all greater than 0.05, indicating no significant differences between the groups. The Reamed Group had significantly better outcomes compared to the Unreamed Group. Conclusions: It was concluded that reamed intramedullary nailing is superior to unreamed nailing in the treatment of Gustilo and Anderson Type II and IIIA open tibial shaft fractures. The reamed group demonstrated higher union rates, faster healing times, lower infection rates, and better functional outcomes.