Leg Tissue Perfusion in Simple Tibial Shaft Fractures Treated with Unreamed and Reamed Nailing

Lindström, Timo; Gullichsen, Eero; Lertola, K; Niinikoski, J

doi:10.1097/00005373-199710000-00012

Cited by 13 publications

(6 citation statements)

References 9 publications

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“…26 An experimental study suggested that intramedullary reaming, although possibly disturbing endosteal circulation, had only a minimal, if any, effect on transcutaneous oxygen tension values and that the depressed skin oximetry values in simple tibial shaft fractures resulted from the primary injury mechanism and not from intramedullary reaming. 27 However, the incidence of delayed union in reamed intramedullary nailing was not superior to that in unreamed intramedullary nailing. A possible reason is that reamed intramedullary nailing may not benefit the early process of fracture healing more than unreamed intramedullary nailing.…”

Section: Discussionmentioning

confidence: 94%

A Meta-analysis of Reamed Versus Unreamed Intramedullary Nailing for the Treatment of Closed Tibial Fractures

Xia¹,

Zhou²,

Mei³

et al. 2014

Orthopedics

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Controversy exists regarding the clinical outcomes of reamed vs unreamed intramedullary nailing in the treatment of closed tibial fractures. This study assessed the effects of reamed vs unreamed intramedullary nailing for closed tibial fractures. The authors searched PubMed, EMBASE, BIOSIS, and the Cochrane Controlled Trials Register for randomized and quasi-randomized controlled clinical trials from January 1980 to June 2012 comparing reamed with unreamed intramedullary nailing for closed tibial fracture in adults. Primary outcomes were nonunion, delayed union, malunion, secondary procedure, failure of implants, compartment syndrome, infection, and knee pain. Eight randomized and 1 quasi-randomized clinical trials (1229 fractures) were included. No statistically significant differences were found between reamed and unreamed nailing groups in delayed union (P=.20), malunion (P=.28), infection (P=.36), compartment syndrome (P=.36), and knee pain (P=.93). The unreamed group had a higher rate of fracture nonunion than the reamed group (P=.02). The subgroup analysis of implant failures (broken screws vs broken nails) indicated that reamed nailing significantly reduced the risk of screw breakage (P<.001); however, there was no significant difference between reamed and unreamed intramedullary nailing in nail breakage (P=.94). The subgroup analysis of a secondary procedure showed that the reamed intramedullary nailing resulted in significantly lower risks of implant exchange (P=.01) and dynamization (P=.04); however, there was no significant difference in bone grafting rate (P=.73). Evidence comparing reamed with unreamed intramedullary nailing for closed tibial fractures indicates that reamed intramedullary nailing may lead to significantly lower risks of nonunion, screw failure, implant exchange, and dynamization without increasing operative complications.

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Section: Discussionmentioning

confidence: 94%

A Meta-analysis of Reamed Versus Unreamed Intramedullary Nailing for the Treatment of Closed Tibial Fractures

Xia¹,

Zhou²,

Mei³

et al. 2014

Orthopedics

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“…However, Bhandari et al [15] showed that reamed nailing reduced the risk of nonunion by 57%, irrespective of whether the fracture was closed or open. Although several biological studies have shown a negative effect of reaming on intramedullary blood fl ow [20] , others have demonstrated that this does not infl uence callus formation [9,15,21,22] .…”

Section: Discussionmentioning

confidence: 99%

Closed and Open Grade I and II Tibial Shaft Fractures Treated by Reamed Intramedullary Nailing

Djahangiri

Garofalo²,

Chevalley³

et al. 2006

Med Princ Pract

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Objective: To evaluate the results of closed and open grade I and II tibial shaft fractures treated by reamed nail and unreamed nailing. Subjects and Methods: Between 1997 and 2000, 119 patients with tibial shaft fractures were treated with reamed tibial nails. Postoperatively 96 patients (70 closed and 26 grade I and II open fractures) were followed clinically and radiologically for up to 18 months. The nail was inserted either by patellar tendon splitting or by nonsplitting technique. The nail was inserted after overreaming by 1.5 mm. Postoperatively, patients with isolated tibial fracture were mobilized by permitting partial weight bearing on the injured leg for 6 weeks. Patients with associated ankle fractures were allowed to walk with a Sarmiento cast. Results: Postoperatively, 6 (6.3%) patients developed a compartment syndrome after surgery. In 48 (50%) cases, dynamization of the nail was carried out after a mean period of 12 weeks for delayed union. Overall, a 90.6% union was obtained at a mean of 24 weeks without difference between closed or open fractures. Two (2.1%) patients with an open grade II fracture developed a deep infection requiring treatment. A 9.4% rate of malunion was observed. Eight (8.3%) patients developed screw failure without clinical consequences. At the last follow-up, 52% of patients with patellar tendon splitting had anterior knee pain, compared to those (14%) who did not have tendon splitting. Conclusion: Reamed intramedullary nail is a suitable implant in treating closed as well as grade I and II open tibial shaft fractures.

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“…12,13 Reaming has been shown to have no detrimental effect on leg perfusion in humans. 14 To the contrary, reaming may result in increased extraosseous blood flow. 15 Reaming has been shown to increase pressure within the intramedullary cavity to 300 mm Hg to 1,500 mm Hg, particularly during the first pass of the reamer.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic Intramedullary Fragmentation of a Tinel Reamer

Darowish

Gorczyca

2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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A 19-year-old male college student was involved in an all-terrain-vehicle versus all-terrain-vehicle crash, sustaining displaced closed distal tibia and fibula shaft fractures. He was presented to a hospital. After considering the treatment options and risks, the patient and his parents decided to proceed with intramedullary fixation of the fracture.Approximately 24 hours after his injury, the patient was taken to the operating room. The operative report states that a medial parapatellar approach was used to approach the proximal tibia. An awl was used to create the starting point in the midline of the proximal tibia, and the proximal tibial metaphysis was hand reamed. The fracture was reduced, and a ball-tipped guide wire was advanced across the fracture and into the distal tibial metaphysis.Reaming of the proximal tibia was initiated with a 9-mm flexible reamer. The 9 mm reamer broke at the junction of the reamer shaft with the reamer. Removal of the ball-tipped guide wire allowed for complete removal of the reamer. The guide wire was replaced within the medullary canal, and its position reconfirmed using orthogonal fluoroscopy. Reaming with an 8 mm reamer was attempted, but this reamer also jammed in the canal, and the reamer shaft fragmented into multiple pieces, proximal to the reamer tip. With attempts at removal of the guide wire, the proximal end of the distal reamer shaft caught on the metaphyseal bone and fragmented further. The guide wire was cut short, and advanced into the medullary canal to not be prominent. The wound was closed ( Fig. 1, A-C). A standard four-pin external fixator was placed to stabilize the fracture without complication. The patient was discharged from the hospital on postoperative day 2.The patient was subsequently referred to the regional trauma center for consideration of the treatment options. At that time, the patient's parapatellar incision was healed, and his external fixator pin sites were noninfected. He was neurovascularly intact throughout his leg and foot. The tibia appeared to be in mild valgus alignment clinically and radiographically. Options were discussed with the patient and his family, including observation, adjustment of the external fixator, and/or removal of the broken reamer fragments. They decided to undergo adjustment of the external fixator and removal of the reamer fragments.The patient returned to surgery 1 month following his initial injury, at which time the initial incision was excised to allow access to the anterior proximal tibia. A curette was used to create an 8 mm by 12 mm cortical window around the protruding guide wire, through which some of the metallic particles were able to be extracted. A vice-grip slap-hammer was then used to extract the incarcerated reamer tip and the guide wire. Upon removal of the reamer tip, it became obvious that the reamer had fragmented at the junction of the reamer tip and the shaft. The remaining metallic fragments were then removed piecemeal from the intramedullary canal using a series of pituitary rongeurs, ceme...

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Leg Tissue Perfusion in Simple Tibial Shaft Fractures Treated with Unreamed and Reamed Nailing

Cited by 13 publications

References 9 publications

A Meta-analysis of Reamed Versus Unreamed Intramedullary Nailing for the Treatment of Closed Tibial Fractures

A Meta-analysis of Reamed Versus Unreamed Intramedullary Nailing for the Treatment of Closed Tibial Fractures

Closed and Open Grade I and II Tibial Shaft Fractures Treated by Reamed Intramedullary Nailing

Catastrophic Intramedullary Fragmentation of a Tinel Reamer

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