Frequency of Union in Open Tibia Fractures treated with Unreamed Intramedullary Interlocking Nails


  • Rafi Ullah Fellow, Ghurki Trust Teaching Hospital, Lahore
  • Akhtar Hussain Resident, Ghurki Trust Teaching Hospital, Lahore
  • Javed Iqbal Medical Officer DHQ Hospital, Shabqadar, Peshawar
  • Anwar Imran Fellow, Ghurki Trust Teaching Hospital, Lahore
  • Sadaf Saddiq Statistician, Ghurki Trust Teaching Hospital, Lahore.
  • Naeem Ahmed Professor of Department of Orthopaedic and spine, Ghurki Trust Teaching Hospital, Lahore


Tibial fractures, unreamed, intramedullary nailing,union


Objectives: To determine the frequency of union in open tibia fractures treated with unreamed interlocking intramedullary tibial nails.

Methods: This descriptive study was conducted in Department of Orthopaedics and Spine Surgery Ghurki Trust Teaching Hospital Lahore from 15th February 2018 to 14th November 2019. All patients with open  diaphyseal tibial fractures fulfilling the inclusion criteria were fixed with unreamed interlocking intramedullary nails. Patients were followed up at intervals for nine months and clinical and radiological union was noted at final follow up visit.

Results: The total number of patients in our study were 214.The mean age of our study participant was 45.47 ± 9.65 years.Male patients were 133(62.15%) and female 88(37.85%).Majority(87.85%,n=188) patients revealed clinical and radiological union at nine months while 26(12.1%) patients had non union.No major complication noted.

Conclusion: High union rate had been achieved in open tibial fractures treated with unreamed interlocking nails.Unreamed interlocking nails therefore, can be used to treat Gustilo Anderson type I and type II diaphyseal fractures of tibia with good results.


Canale ST, ed. Campbell's Operative Orthopaedics,. 10th ed. St Louis, Mo: Mosby-Year Book; 4321-42.

Koval KJ, Zuckerman JD, eds. Handbook of Fractures. 2nd ed. Baltimore, Md: Lippincott, Williams & Wilkins; 332-41.

Haq SNU, Kumar S. Distribution of open diaphysial fractures of tibia gustilo type IIIA and IIIB. Gomal J Med Sci. 2017;15:38-41.

Gawarte DP, Moradiya DN, Patel DK, Desai DTV. Proximal and distal metaphyseo diaphyseal fractures of tibia in adults treated with tibia interlock nail with multiaxial locking (A Study of 30 Cases). Int J Ortho Sci. 2017;3(1):308-13.

Kumar R, Sujai S, Chethan, Nanjundappa HC, Swamy S. Results of open fractures of tibia treated by external fixator as primary and definitive procedure. Int J Ortho Sci. 2017;3(1):179-81.

Devaprasad S. Evaluation of fracture healing of intramedullary interlocking nailing of long bones of femur and tibia after early and delayed weight bearing. Int J Curr Med Appl Sci. 2015;6(2):155-8.

Borrelli J. Management of soft tissue injuries associated with tibial plateau fractures. J Knee Surg. 2014;27(1):5-9.

Foote CJ, Guyatt GH, Vignesh KN, Mundi R, Chaudhry H, Heels-Ansdell D at el. Which surgical treatment for open tibial shaft fractures results in the fewest reoperations? A network meta-analysis. Clin Orthop Relat Res. 2015;473(7):2179-92.

Chauhan N, Somashekarappa T, Singh A, Singh G, Rawal A. Interlocking nail in diaphyseal fracture of tibia: A clinical study. Int J Contemp Med Res. 2016;3(6):1678-81.

Kuhn S, Appelmann P, Pairon P, Gruszka D, Rommens PM. Retrograde tibial nail: Anatomical implantation and surgical feasibility study. Acta Chir Ortho Et Trauma Cechosl. 2015;82:203–8.

Kuhn S, Appelmann P, Pairon P, Mehler D, Hartmann F, Rommens PM. A new angle stable nailing concept for the treatment of distal tibia fractures. Int Ortho. 2014;38:1255–60.

Chandra CP, Rao KCS, Reddy AK, Srinivas B. A study on internal fixation of compound fractures of tibia using interlocking nail without reaming. J. Evol Med. 2016;5(45):2797-2800.

Nicoll EA. Fractures of the tibial shaft, a survey of 705 cases. J Bone Joint Surg Br 1964; 46:373–387.

Brown PW, Urban JG. Early weight bearing treatment of open fractures of the tibia. An end-result study of 63 cases. J Bone Joint Surg Am 1969; 51:59–75.

Sarmiento A, Latta LL. Functional fracture bracing. J Am Acad Orthop Surg 1999; 7:66–75.

Edwards CC. Staged reconstruction of complex open tibial fractures using Hoffmann external fixation. Clinical decisions and dilemmas. ClinOrthop 1983; 178:130–161.

Watson JT, Ripple S, Hoshaw SJ. Hybrid external fixation for tibial plateau fractures: clinical and biomechanical correlation. Orthop Clin North Am 2002; 33:199–209.

Patzakis MJ, Wilkins J. Factors influencing rate in open fracture wounds. Clin Orthop Relat Res 1989; 243:36–40.

Chapman MW. The use of immediate internal fixation in open fractures. Orthop Clin North Am 1980; 11:579–591.

Farouk O, Krettek C, Miclau T. Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 1997; 28(Suppl 1):7–12.

Lottes JO. Medullary nailing of the tibia with the triflange nail. Clin Orthop 1974; 105:253–266.

Chapman MW. The role of intramedullary fixation in open fractures. Clin Orthop 1986; 212:26–34.

Bhandari M, Guyatt G, Tornetta P, Schemitsch EH, Swiontkowski M, Sanders D et al. Randomized trial of reamed and undreamed intramedullary nailing of tibial shaft fractures. J Bone joint Surg Am 2008; 90:2567–2578.

Bonatus LB, Kassman S, Stegemann P, France J. Prospective study of union rate of open tibial fractures treated with locked unreamed intramedullary nails. J Orthop Trauma 1994; 8:45–49.

Walia JPS, Gupta AC, Kalaivanan K, Singh S. Role of Interlock Nailing of Tibial Diaphyseal Fractures Done Under Image Intensifier- a Study of 25 Cases. Pb Journal of Orthopaedics. 2010;12(1):1-4.

Kamruzzaman AHSM, Islam S. Result of closed interlocking intramedullary nail in tibial shaft fracture. Bang Med J (Khulna). 2011;44:15-7.

Akhtar A, Shami A, Wani GR, Gul MS. Management of Diaphyseal Tibia Fractures with Interlocking Sign Nail after Open Reduction without Using Image Intensifier. Ann Pak Inst Med Sci. 2013;9(1):17-21.

Neeraj M. Minimally Invasive Techniques in Distal Tibial Fractures. J K Sci. 2008;10(2):78-80.

Williams J, Gibbons M, Trundle H, Murray D, and Worlock P. Complications of nailing in closed tibial fractures. J Orthop Trauma. 1995;9:476-81.

Singer BR, McLauchlan GJ, Robinson CM, and Christie J. Epidemiology of fractures in 15 000 adults. The influence of age and gender. J Bone Joint Surg. 1998;80-B:243–48.

Chiu FY, Lo WH, Chen CM, Chen TH, Huan CK. Unstable closed tibial shaft fractures: a prospective evaluation of surgical treatment. Journal of Trauma 1996 Jun;40(6):987-91.

Joshi D, Ahmed A, Krishna L, Lal Y. Unreamed interlocking nailing in open fractures of tibia. J OrthopSurg (Hong Kong) 2004 Dec;12(2):216-21.

Seron S, Rasool MN. Outcomes of intramedullary nailing for open fractures of the tibial shaft. SA Orthop J 2018;17(1):24-29.

Pape H-C, Giannoudis P. The biological and physiological effects of intramedullary reaming. J Bone Joint Surg br. 2007;89-B:1421-26.

Reichert I, McCarthy I, Hughes S. The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia. J Bone Joint Surg Br. 1995;77-B(3):490-93.

Larsen LB, Madsen JE, Hoiness PR, Ovre S. Should Insertion of Intramedullary Nails for Tibial Fractures Be With or Without Reaming?: A Prospective, Randomized Study With 3.8 Years’ Follow-up. J Orthop Trauma. 2004;18:144-49.

Ziran BH, Darowish M, Klatt B, Agudelo J, Smith W. Intramedullary nailing in open tibia fractures: A comparison of two techniques. Int Ortho. 2004;28:235-38.

Keating J, O’Brien P, Blachut P, Meek R, Broekhuyse H. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am. 1997;79-A:334-41.

Shao Y, Zou H, Chen S, Shan J. Meta-analysis of reamed versus undreamed intramedullary nailing for open tibial fractures. J Orthop Surg Res. 2014;9:74.

Whittle AP, Taylor CJ. Treatment of open fractures of the tibial shaft with the use of interlocking nailing without reaming. J Bone Joint Surg (Am). 1992;74,1162-1171.

Oh CW,Park C,Ihn JC,Park HJ.Primary unreamed intramedullary nailing for open fractures of the tibia.International Orthopaedics.2001;24(6):338-41.

union in open tibia




How to Cite

Rafi Ullah, Akhtar Hussain, Javed Iqbal, Anwar Imran, Sadaf Saddiq, & Naeem Ahmed. (2020). Frequency of Union in Open Tibia Fractures treated with Unreamed Intramedullary Interlocking Nails. Journal of Pakistan Orthopaedic Association, 32(02), 87–91. Retrieved from

Most read articles by the same author(s)