الفهرس 
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Abstract
The earliest varieties of intramedullary nail for the tibia to become popular were inserted in an unreamed, unlocked fashion. The rigid nail of Lottes(81,82) and the flexible nails of Enders(83,84) have been used with success. These early types of tibial nails did not have interlocking capability, and thus they did not provide rotational stability nor resistance to shortening beyond that offered by the fracture pattern. About 23% of all tibial fractures are open(85,86). Although the numbers of patients in previous studies have been small, the differences in outcome have been considerable. Some surgeons advocate external fixation and others prefer reamed or unreamed intramedullary nailing. (87) The success of locking nails for the treatment of closed tibial fractures has stimulated interest in their use for open tibial fractures. (88) Intramedullary nailing after reaming is now accepted as the method of choice to treat open femoral fractures, (89,90,91) but its use remains controversial with regard to open tibial fractures. The vascular damage inflicted by reaming in association with the soft¬tissue injury has been thought to increase the risk of infection and delayed union to an unacceptable level. (92) Early reports of the use of unlocked nails with reaming for open tibial fractures seemed to confirm this view. (93) Recent authors have shown the amount of injury that reaming does to the endosteal vasculature and the cortical blood supply. (94,95) The effect of reaming is similar to experimentally ligating the nutrient artery, and results in necrosis of the inner 50 to 70% of the cortex. The damage is done with the first pass of the reamer, and sUbse~uent reaming seems to have little additional effect on vasculature. (95 Locking nailing without reaming causes less damage to the intramedullary blood supply and is considered b~ some to be a safer method of treatment for open tibial fractures. (95, 6) Although the concept of locking nailing without reaming has had widespread