Aim: To determine whether there is a difference in outcome between reamed and unreamed tibial nails.

Method: We performed a prospective, randomised trial comparing the results of reamed versus unreamed titanium tibial nails. Perioperative oxygen saturation and FIo2 were measured in each patient. Time to union was compared using survival analysis.

Results: There were 60 patients with 60 tibial shaft fractures including 10 (17%) compound fractures and three patients with thoracic trauma. There were 32 reamed and 28 unreamed nails. Fifty-seven nails were statically locked (95%). The average nail diameter in the reamed group was 9.7mm, significantly larger than that in the unreamed group (9.2mm), (p=0.02). There were no significant differences in average oxygen saturation and FIo2 between reamed and unreamed nails during insertion, immediately postoperatively or during the first two postoperative days. Forty-eight (80%) patients were followed until the fracture healed. Two patients died and 10 (17%) were lost to follow up. The mean time to union was 13.5 weeks in the reamed group versus 16 weeks in the unreamed group. This was not significant (p=0.2). There were 10 (17%) complications including one delayed union in each group, both united following ‘dynamization’. There were three compartment syndromes treated with fasciotomies. No nails broke and there were no deep infections.

Conclusion: We have shown no difference in the effects on pulmonary function between the two groups, but unfortunately we had insufficient patients to assess the effect of thoracic trauma.