Unreamed Nails

Due to the good results of unreamed nails in open tibial fractures, their use is becoming widespread in closed tibial diaphysis fractures. Several complications have been reported with these nails: breakage of locking screws, vicious consolidation, breakage of the nail and patellar femoral pain have been the most frequently observed.

Many workers observed a higher incidence of complications in unreamed nails than inreamed nails. Consolidation time was shorter in unreamed nails and complications, such as breakage of locking screws and vicious joints, were significantly more numerous in the unreamed group. Other authors found a higher incidence of pseudoarthrosis and patellofemoral pain in unreamed tibia nails than inreamed ones. Consolidation time was significantly longer.

The breakage of locking screws reported by several authors is between 12 and 20 percent. In our case it was 6.4 percent. This complication could be avoided or its incidence reduced by delaying the load until the dynamization of the nail.

We have frequently observed femoropatellar pain. Other surgeons also observed this complication more frequently in non-drilled nails than in drilled ones. This may be due to the fact that the entry point is quite high and when the nail is dynamized it protrudes proximally causing irritation of the patellar tendon.

A higher incidence of pseudoarthrosis has also been found in unreamed nails than inreamed nails. Consolidation time was also longer. It is advisable to dynamize the nail before twelve weeks. We believe it is advisable to dynamize the nail between the sixth and twelfth weeks.

Intraoperative complications, such as posterior cortex rupture, could be avoided by well-selecting the elavo entry point and placing the knee in flexion greater than 90°. The nail should also be inserted as parallel as possible to the tibia. There have also been reports of comminution of the proximal tibia during surgery.

Other complications may include pulmonary embolism, deep and superficial infections, compartment syndromes, peroneal nerve involvement and deep vein thrombosis. We think that some of the complications derived from the use of this nail can be avoided by using it correctly and knowing its characteristics and limitations.