Clinical Outcome of Ream Versus Unream Intramedullary Nailing for Femoral Shaft Fractures

Abstract

BackgroundStabilization of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults; however, to ream or not to ream is still being debated.ObjectivesThe primary objective of this study was to determine clinical results following unreamed versus ream intramedullary nailing of femoral fractures.Patients and MethodsBetween January 2008 and August 2009, 50 patients with femoral shaft fractures were treated with unreamed or reamed femoral nails in our clinic. From this prospective single centre study, 16 patients were excluded due to insufficient follow-up data. According to the AO classification, fractures in this study were either type A or B. Dynamic proximal locking was performed in all cases. The remaining 34 patients were divided into two groups of 17 with ream or unream nailing. During and after the operation, we evaluated some variables in whole series.ResultsAfter statistical analyzes, we found that there were no differences in radiologic union time (P = 1) or full weight bearing time (P = 0.73) between ream and unream nailing. Nail breakage or iatrogenic fractures during nail insertion did not occur and we did not have any fat emboli in both groups but one secondary loss of reduction occurred in the unream group. Superficial infection after the operation was seen in one case which was treated successfully with antibiotics. In the ream group surgical time was about thirty minutes longer and differences were significant (P = 0.000). Patients had to pay more for ream nailing but the difference was not significant. We found no statistical difference between union time with or without reaming; on the other hand, there was significant increased operation length, blood loss and systemic changes in BP or So2 in the ream group versus the unream group.ConclusionsWe advocate that unream nailing in traumatic femoral shaft fractures is a simple, safe and effective procedure with significant advantages, especially in multitrauma patients.

Reamed versus unreamed intramedullary nailing for the treatment of femoral fractures

“…No cases of FES were documented in any of the included studies. [7,8,14–16,23–25] We found no obvious differences in ARDS or mortality rate between the 2 groups.…”

“…Of these, 2 were excluded as not randomized clinical trials; 15 trials were excluded due to the uninteresting outcomes; 19 studies were excluded as reviews articles; and 1 study was excluded because it was a preliminary report. [22] The remaining 8 articles [7,8,14–16,23–25] were included in this meta-analysis. Of these 8 studies, 2 were multicenter, randomized, controlled clinical trials and 6 were from a single investigational site and studied patients with femoral fractures.…”

“…The randomization technique was mentioned in 4 trials, [8,14,24,25] and information of allocation concealment was not provided for 5 studies. [7,14–16,23–25] Because there was no difference in the postoperative radiological data between the 2 groups; thus, the term “blinding of outcome assessment” was assessed as “low risk” for all 8 studies.…”

“…Thus, only the major adverse events including the incidence of nonunion, delayed-union, fixation failure, infection, acute respiratory distress syndrome (ARDS), and mortality were embedded into the meta-analysis for evaluation. Five studies [7,14–16,23] reported the incidence of implant failure, with a low frequency in both groups.…”

“…[40,41] In all included studies, the rate of infective complications was low and only 2 studies reported infective complications. [8,23] In 1 study, there were 4 cases with infection (3 superficial and 1 deep infection). [8,23] However, the number of infections for each group was not reported.…”