SPRINT

Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures.

Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures Investigators, Bhandari M, Guyatt G, et al. The Journal of bone and joint surgery. American volume 2008 · PMID 19047701 · doi:10.2106/jbjs.g.01694

Question

Does reamed intramedullary nailing of tibial shaft fractures reduce reoperations compared with unreamed nailing?

Design

International multicentre RCT with blinded adjudication of outcomes.

Patients

Adults with open or closed tibial shaft fractures treated with intramedullary nailing.

Intervention

Reamed intramedullary nailing

Comparison

Unreamed intramedullary nailing

Primary outcome

Composite of reoperation or autodynamisation for nonunion, infection or other complications within 12 months

Key result

Reamed nailing reduced events in closed fractures, an effect largely due to fewer autodynamisations, with no clear difference in open fractures. The trial also showed that delaying reoperation for nonunion for at least 6 months reduces unnecessary procedures.

Limitations

The closed fracture benefit was driven by a soft outcome (autodynamisation), and the open fracture subgroup may have lacked power.

Impact on practice

Reamed nailing became the standard for closed tibial shaft fractures and is acceptable in open fractures, and it underpins waiting at least 6 months before intervening for suspected nonunion.