Abstract
Introduction: We sought to determine the 1 year patient based outcomes and return to activities for patients with tibia fractures in a randomized trial of reamed and unreamed nail insertion.
Methods: 1226 patients with 830 closed and 392 open tibial shaft fractures were enrolled in a randomized trial comparing reamed with unreamed tibial nail insertion and completed one year follow-up. The average age was 39±16 and 74% were male. Patient based outcomes were determined using the validated SF-36 PCS, the SMFA, and a published return to activity questionnaire. Statistical analysis was performed as a stratified analysis comparing the groups with p < 0.05 designated as significant.
Results: There was no difference in any outcome parameter for any time frame between the reamed and unreamed groups. The 1 year SF36 PCS (a 100 point scale with a mean of 50 in the general population, higher better) was 42.9±11 for the reamed group and 43.5±11 for unreamed group as compared with 52.5±9 for the reamed group and 53.1±9 for the unreamed group pre-injury. The 1 year SMFA (100 point scale, higher is worse) was 18±17 for the reamed group and 17.5±17 for the unreamed group as compared with 7.9±13 for the reamed group and 7.7±13 unreamed group pre-injury.
Conclusion: In patients with tibial shaft fractures treated with intramedullary nails, patient based outcomes are not related to reamed or unreamed insertion. Patients do not return to their preinjury status based on validated outcomes assessments or return to activity by one year after injury.
Correspondence should be addressed to Dr. D. Hak, Email: David.Hak@dhha.org
