Clinical Outcomes of Reamed Versus Unreamed Interlocking Nailing for Tibial Shaft Fractures: A Comparative Study in a Tertiary Care Hospital

Background: Tibial shaft fractures comprise 2-3% of all fractures and are the most prevalent long bone fractures inorthopedics, typically resulting from high-energy trauma in younger adults and low-energy injuries in the elderly.Management challenges include soft tissue injuries, delayed union, and infection, making early restoration of limb functioncrucial. Intramedullary interlocking nailing is the gold standard for displaced tibial fractures, providing stable fixation withminimal vascular disruption to facilitate early rehabilitation. A debate exists between reamed and unreamed nailingtechniques: reamed nailing offers increased stability but may compromise blood supply and extend operative time.Materials and Methods: This study aimed to evaluate clinical outcomes between reamed and unreamed nailing techniquesin 80 patients at a tertiary care hospital, focusing on union rates, complications, and functional recovery. Results: The studyobserved that 95% of patients in the reamed group achieved full weight-bearing by 24 weeks alongside a 100% union rate,compared to 77.5% and 82.5% in the unreamed group, respectively. Mean union times were also significantly shorter forreamed nailing (20.8 weeks) versus unreamed nailing (24.9 weeks). A higher incidence of complications, notably screwfailures and delayed union, was reported in the unreamed group. Functional outcomes favored the reamed technique, withmore patients achieving excellent or good outcomes according to the Johner and Wruhs criteria. Conclusion: The studyconcludes that reamed intramedullary nailing offers superior clinical and radiological results for most closed and Gustilo-Anderson Type I tibial shaft fractures, providing faster recovery and fewer complications. While unreamed nailing has itsplace, particularly in cases needing preservation of soft tissue integrity, it is associated with higher rates of complicationsand inferior outcomes. Recommendations for future research include larger multicenter trials to further refine treatmentguidelines.