Thermal Necrosis After Tibial Reaming for Intramedullary Nail Fixation

Leunig, Michael; Hertel, R.

doi:10.1302/0301-620x.78b4.0780584

Cited by 95 publications

(66 citation statements)

References 21 publications

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“…There are many studies that document the severe disruption of endosteal circulation with reaming and subsequent bone necrosis [4,16,19,25]. Klein et al demonstrated a severe vascular insult with aggressive reaming in dog tibiae [17]; Melcher showed an increased rate of infection with reaming in rabbit tibia fractures [20,21].…”

Section: Discussionmentioning

confidence: 99%

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

Ziran

Darowish

Klatt

et al. 2004

International Orthopaedics (SICOT)

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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.

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Section: Discussionmentioning

confidence: 99%

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

Ziran

Darowish

Klatt

et al. 2004

International Orthopaedics (SICOT)

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“…The deleterious consequences of local hyperthermia induced by intramedullary reaming as a complication of intramedullary fixation of tibial fractures are occasionally noted in the literature [11,13,15,16]. Friction forces involved in reaming of the intramedullary canal generate a rise in temperature of the surrounding tissues that, under controlled conditions, is reported in vivo between 0.5°C and 16°C for a maximum of 15 seconds [7].…”

Section: Introductionmentioning

confidence: 99%

“…Temperatures as high as 175-225°C after two minutes of reaming have been estimated with subsequent development of irreversible thermal damage to bone and surrounding tissues [1]. We are aware of six reported patients with osteocutaneous thermal necrosis, all involving the tibia [11,13,15]. A seventh case of segmental bone necrosis without associated soft tissue necrosis has been reported after intramedullary reaming of the humerus [13].…”

Section: Introductionmentioning

confidence: 99%

“…A seventh case of segmental bone necrosis without associated soft tissue necrosis has been reported after intramedullary reaming of the humerus [13]. Secondary exposure of a devitalised fracture site and the intramedullary device within necrotic tissues with subsequent osteomyelitis was noted in all of these patients [11,13,15]. The lower leg is probably at higher risk for the development of osteocutaneous thermal necrosis as a result of its trifoil shape of tibia and relatively thin soft tissue envelope.…”

Section: Introductionmentioning

confidence: 99%

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Osteocutaneous thermal necrosis of the leg salvaged by TSF/Ilizarov reconstruction. Report of 7 patients

Lovisetti

Sala

Thabet

et al. 2010

International Orthopaedics (SICOT)

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“…9 The recent use of locked intramedullary nail has shown promising results. 10 It has also given satisfactory result in proximal third tibial shaft fracture and segmental tibial shaft fracture. 11 Reamed interlocking nails also have comparable results to those of unreamed nailing in open fractures.…”

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confidence: 96%

Functional Outcome of Interlocking Nailing of Type I and Ii Compound Fracture Tibia

Baby¹,

Kunjappan²

2018

jemds

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BACKGROUND Introduction of closed locked intramedullary nailing has revolutionised the management of fractures of femur and tibia. The study is to prove type-I and type-II open fractures with comparatively less soft tissue damage and contamination, can be safely managed by debridement, early wound care and an unreamed/ reamed interlocking nailing without any deep infection hence allowing early mobilisation, reducing morbidity, reducing reoperation/ secondary procedures and malunion/ non-union. MATERIALS AND METHODSA prospective observational study was approved by the Hospital Ethical Committee and an informed consent was taken from all patients. 30 patients who underwent IL nailing from March 2011 to 2012 were enrolled in this study. Of the 30 patients, 17(56.7%) patients had fracture in right tibia and 13(43.3%) had fracture in left tibia. Age of the patients ranged from 18 to 65 years with mean age being 35.5. Males dominated (73.3%) in this study population and the sex ratio was found to be 2.75. Females were represented by only 26.7%. RESULTSIn this study all the cases united irrespective of the Gustilo and Anderson (G and A), OTA classification, Level of fracture and Mode of injury. Time of union ranges between 15 to 24 weeks with mean time of union is 20.1. Shortest time for a union was within 15 weeks (1 case) which was grade I Gustilo and Anderson, middle 3 rd , transverse, OTA-A fracture and maximum time taken was a period of 24 weeks (2 cases) which were type II, lower3 rd fractures. From this, it is observed that there is a difference in union rate between Level, Gustilo and Anderson, and OTA classifications. In this study, it is observed that there were no cases of deep infection. CONCLUSIONClosed interlocking intramedullary nailing is an effective method of treatment for Gustilo and Anderson type I and II compound tibial diaphyseal fractures. It is based on the principle of promoting biological healing and allows gradual weight bearing. Closed nailing and static locking is a technically demanding procedure. Risk of exposure to radiation is there. This method offers the possibility of maintenance of length, alignment and rotational stability in fractures of the tibial shaft, while preserving the biological environment of fracture healing. The fixation is rigid, hence there is no need for external immobilisation prior to callus formation and weight bearing. KEYWORDSCompound Fracture Tibia, Gustilo and Anderson (G and A) Classification, Interlocking Intramedullary Nailing. HOW TO CITE THIS ARTICLE: Baby S, Kunjappan MM. Functional outcome of interlocking nailing of type I and II compound fracture tibia.

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Thermal Necrosis After Tibial Reaming for Intramedullary Nail Fixation

Cited by 95 publications

References 21 publications

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

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

Osteocutaneous thermal necrosis of the leg salvaged by TSF/Ilizarov reconstruction. Report of 7 patients

Functional Outcome of Interlocking Nailing of Type I and Ii Compound Fracture Tibia

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