Background:While most surgeons agree that intramedullary nails are
the implant of choice in the treatment of tibial shaft
fractures, the decision to ream the intramedullary canal prior
to nail insertion remains controversial. We therefore conducted
an international survey of practicing orthopedic surgeons with
an interest in fracture care (1) to identify surgeons’ beliefs
regarding the risks of infection and nonunion with
intramedullary reaming, and (2) to identify factors associated
with surgeons’ beliefs.Material and
Methods:We utilized focus groups, key informants and sampling to
redundancy strategies to develop a survey to examine surgeons’
preferences in the treatment of tibial shaft fractures. We
mailed this survey to members of the Orthopedic Trauma
Association, American Academy of Orthopedic Surgeons, and
European trauma centers affiliated with AO International.Results:Of the 577 surgeons surveyed, 444 (77%) responded. Of the
respondents, 60% had an academic practice, 84% supervised
residents, and 65.1% had fellowship training in trauma.
Surgeons, in general, believed reamed nails decreased the risk
of nonunion and had no effect on infection risk in closed tibial
shaft fractures; however, surgeons, on average, believed that
there was no difference in reducing the risk of nonunion or
infection in patients with open tibial shaft fractures. Surgeons
aged > 50 years, those with past trauma fellowship training,
and those practicing in North America were more likely to
believe reamed intramedullary nailing reduced nonunion
rates.Conclusion:The continued disagreement and controversy reflect the
lack of definitive evidence regarding the relative merits of the
two approaches, and indicate that more studies are needed to
resolve this issue.
