Abstract
Purpose
The SPRINT trial randomized 1226 patients with tibial shaft fractures treated by intramedullary (IM) nailing to reamed versus unreamed groups. Using data from this trial, we completed a subgroup analysis of those patients who required two or more reoperations following the initial IM fracture stabilization.
Method
We identified 44 patients with tibial shaft fractures who required two or more reoperations following IM nailing. We considered those that were reamed vs unreamed, open vs closed, those that were planned for reoperation after the 12 month follow up, and the indications for reoperation.
Results
Patients that had two or more reoperations were characterized by having more open fractures and fractures of greater severity. Fifteen of 21 (71%) reamed and 10 of 23 unreamed (43%) patients required reoperation to treat infection as their first surgical intervention. Those patients that were initially reamed who developed an infection required a greater number of subsequent surgical procedures compared to those who were not initially reamed (42, 60.8% versus 27, 39.2).
Conclusion
Our data suggest that patients whose tibial fractures are reamed and subsequently develop an infection are at risk of requiring more re-operations in the future compared to those whose fractures were not reamed. Further study is required to assess the corroborating consequences of needing multiple re-operations including economic impact, pain and function, as well as strategies to prevent further morbidity in this high risk group of patients.
