As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was ≥ 3 mm.

Aim: The results of open tibial shaft fractures treated with reamed intramedullary nailing are presented. The same nail and protocol of treatent was used in all patients.

Patients and Methods: Twenty patients (mean age 25.2 years, s.d.: 6.0) with open tibial shaft fracture. The fractures were classified according to Gustillo classification (grade-I: 7, grade-II: 6, grade-IIIA: 7), and the comminution according to Winquist-Hansen classification (stable: 7, unstable: 13). All patients were treated within 6 hours from the injury, the wound was left open, followed by wound inspection and re-debridement (if needed) after 48 hours. A delayed primary suture or wound coverage was applied within 4–6 days.

Results: Eighteen fractures united with no need for additional operation. Non-union developed in 2 grade IIIA fractures (1 fracture healed after exchange nailing, and 1 fracture required an alternative method of treatment. The mean union time was 22.7 weeks (grade I: 20.2 weeks, grade II: 20.3 weeks, grade IIIA: 26.3 weeks). There was no infection. Dynamisation was applied in 7 fractures.

Conclusion: The results in this small series of open tibial shaft fractures treated with reamed intramedullary nailing are satisfactory and in accordance with the results of large larger-scale studies published (the recent years) recently in the literature.