Evidence brief
Reamed Intramedullary Nailing versus Unreamed Intramedullary Nailing for Open and Closed Tibial Fractures
Reamed nailing reduced reoperation risk in closed tibial fractures (RR 0.67)
No significant difference in open tibial fractures
Primary outcome: reoperation within 12 months
1,319 patients randomized across 29 centers
Subgroup analysis showed reaming benefit mainly in closed fractures
The SPRINT trial established that reamed intramedullary nailing is superior to unreamed nailing for closed tibial shaft fractures, reducing the need for reoperation. For open fractures, the difference was not significant, supporting either approach.
Key viva question: 'Do you ream for tibial shaft fractures?' Answer: Yes for closed fractures (SPRINT trial showed reduced reoperations). For open fractures, both acceptable. Know the relative risk reduction (33% fewer reoperations with reaming in closed fractures).
Level I
Systematic review of RCTs or high-quality RCT