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Sự phát triển của móng tay intramedullary đường kính nhỏ lồng vào nhau có thể được chèn mà không reaming cung cấp một lựa chọn cố định cho mở trục gãy xương chày. Nonreamed intramedullary đóng đinh của những thương tích này tạo điều kiện cho mô mềm quản lý mà không có sự gia tăng tỷ lệ nhiễm trùng | Nonreamed Intramedullary Nailing of Open Tibial Fractures Melbourne D. Boynton MD and Gregory J. Schmeling MD Abstract The development of small-diameter interlocking intramedullary nails that can be inserted without reaming provides a fixation option for open tibial-shaft fractures. Nonreamed intramedullary nailing of these injuries facilitates soft-tissue management without an increase in infection or nonunion rates relative to external fixation. Reaming is not required which means less injury to the tibial endosteal blood supply. Proximal and distal interlocking maintains better bone alignment than is possible with semirigid or noninterlocking intramedullary nails. The technique of using these devices with static interlocking is described as are some suggested techniques for avoiding complications. J Am Acad Orthop Surg 1994 2 107-114 Open tibial-shaft fractures remain a difficult challenge for the orthopaedic surgeon. The primary goal of treatment is to obtain a functional extremity which usually necessitates removal of devitalized tissue stabilization of the bone and reconstruction of the soft-tissue envelope. A healed noninfected soft-tissue envelope is required to provide the optimal environment for vascular ingrowth and subsequent bone healing. At the time of injury both the endosteal and the periosteal blood supply are damaged.1 The endosteal vessels supply the inner two thirds of the cortex and the periosteal vessels supply the outer third. The extent of damage and the length of the vascular recovery phase determine the time to bone union and the resistance to infection. Accordingly further disruption of the blood supply should be avoided during fracture management. Nonreamed intramedullary nailing of open tibial fractures has received a great deal of interest recently because it appears to meet the objectives required to optimize treatment. The indications technique and complications will be discussed with special attention to the advantages of this .