Intramedullary nailing in open tibia fractures: a comparison of two techniques

Abstract

We analyzed 51 patients with open tibial fractures treated with intramedullary nailing. In 29 patients the nailing was performed without reaming and in 22 after the "reamed-to-fit" technique. There was no statistically significant difference in the rate of union. The nonreamed group required a greater number of secondary procedures to achieve union and had a higher but not statistically significant incidence of infection. Analysis of the operative and anesthesia cost associated with the additional procedures revealed that on average, patients receiving nonreamed nailing incurred a cost of $4,900 more per fracture than patients of the reamed-to-fit technique. The healing rates of open tibia fractures using either minimally reamed or nonreamed techniques of intramedullary nailing are comparable. No increase in the rate of infection with the reamed-to-fit technique was found. A significant increase in the number of secondary procedures required to achieve union was found with the nonreamed nailing technique.Résumé Nous avons analysé 51 malades avec une fracture tibiale ouverte traitée par enclouage centromédul-laire. Pour 29 malades l'enclouage a été exécuté sans alésage et pour 22 avec la technique d'alésage adapté. Il n'y avait aucune différence statistique dans le taux de consolidation. Le groupe sans alésage a exigé un plus grand nombre de gestes secondaires pour obtenir la consolidation et avait un plus grande fréquence d'infection sans que cela soit statistiquement significatif. L'analyse du coût opératoire et de l'anesthésie, associée aux procédures supplémentaires montre qu'en moyenne un malade traité sans alésage a un coût de €4,100 de plus par fracture que le malade avec la technique d'alésage adapté. es taux de consolidation des fractures tibiales ouvertes en utilisant l'enclouage avec alésage adapté ou les techniques sans alésage sont comparables. Aucune augmentation dans le taux d'infection avec la technique d'alésage adapté n'a été trouvée. Une augmentation notable du nombre de procédures secondaires nécessaires pour obtenir la consolidation a été notée avec la technique de l'enclouage sans alésage.

Role of early Ilizarov ring fixator in the definitive management of type II, IIIA and IIIB open tibial shaft fractures

“…This is in contrast to IM nailing which interferes with the intramedullary circulation. The interference with circulation is seen with both unreamed and reamed IM nailing, although the degree of compromise is a matter of controversy [20].…”

Economic Evaluation of Reamed versus Unreamed Intramedullary Nailing in Patients with Closed and Open Tibial Fractures: Results from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT)

“…A systematic search of the literature (MEDLINE, Cochrane Library, and HEED from March 1988 to November 2009) revealed only two economic evaluations of reamed versus unreamed intramedullary nailing [6,7]. The first analysis was a single center, observational study in 51 patients with open tibia fractures [6].…”

“…The first analysis was a single center, observational study in 51 patients with open tibia fractures [6]. Conducted from the hospital perspective, it found a trend toward lower costs due to fewer secondary procedures with reamed intramedullary nailing while healing rates remained similar for the two approaches [6].…”

“…The first analysis was a single center, observational study in 51 patients with open tibia fractures [6]. Conducted from the hospital perspective, it found a trend toward lower costs due to fewer secondary procedures with reamed intramedullary nailing while healing rates remained similar for the two approaches [6]. The second was a model-based analysis using data from small randomized clinical trials with methodological limitations; it explored the cost associated with the treatment of lowenergy tibial shaft fractures and found that there were higher costs associated with treatment with unreamed intramedullary when compared to reamed intramedullary nailing [7].…”

L’inchiodamento tibiale

“…Queste fratture sono spesso il risultato di traumi a elevata energia, soprattutto traumi della strada, o di incidenti sul lavoro a seguito di cadute dall'alto oppure di traumi sportivi [1]. L'inchiodamento endomidollare bloccato è attualmente considerato il trattamento elettivo per la maggior parte delle fratture della diafisi tibiale chiuse [2] ed esposte di tipo I e II di G.A., purché avvenga entro le prime sei ore dal trauma [3]. L'indicazione elettiva di questa metodica sono le fratture di tibia tipo 4.2 secondo la classificazione AO e secondariamente le 4.3, anch'esse trattate con successo.…”