A large United States/Canada cooperative project is underway to resolve differences of opinion on the best way to repair the most common long bone fracture in the human body.
The three-year study of the repair of fractures of the tibia (the larger of the two lower leg bones) will enroll 900 patients at 10 centers in the United States, 10 centers in Canada, and 1 center in Europe. Co-funding the project are the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a component of the U.S. National Institutes of Health, and two institutes of the Canadian Institutes of Health Research: the Institute of Musculoskeletal Health and Arthritis and the Institute of Health Services and Policy Research.
Surgeons agree that repair of serious tibial fractures should include the insertion of a nail into the canal within the central marrow cavity of the bone. They disagree, however, on whether it is better to enlarge (ream) the canal before inserting the nail. Proponents of reaming believe reaming increases blood flow to the hard bone at the outer surface of the fracture site, thus increasing fracture stability. They also believe reaming provides a natural graft of the patient's own bone tissue at the fracture site. Opponents believe that reaming damages the blood supply to the tissue lining the canal, impairing fracture healing.
During the study, patients who have a tibial fracture will be randomly assigned to either a reaming or nonreaming surgical group. At six weeks, three months, six months, nine months, and one year, surgeons will examine participants to determine whether the operation was successful or whether they require additional surgery to promote fracture healing. These operations would include a bone graft, exchange or removal of the nail, removal of the locking screws, or procedures to treat soft tissue infections or defects. Other factors will be considered in determining which group has a more successful outcome, including how soon patients return to work and their general health status and quality of life.