Journal of Musculoskeletal Trauma

Reamed versus Unreamed Interlocking Intramedullary Nailing in the Treatment of Femoral and Tibial Shaft Fracture: Sung Soo Kim, Chul Hong Kim, Myung Jin Lee, Jin Hun Kang; J Korean Fract Soc 2006;19(2):141-146. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.141

Abstract: PURPOSE
To comparative analysis of clincal difference between reamed and unreamed interlocking intramedullary nailing in the treatment of femoral and tibial shaft fractures.
MATERIALS AND METHODS
We reviewed femoral and tibial shaft fracture who were treated with reamed or unreamed nail. They were followed for a minimum of 16 months. Winquist-Hansen and Johner-Wruhs criteria were applied for the classification of the fractures. Retrospectively we evaluated the duration of operation, the amount of bleeding, the first time of callus formation, union time, the time of partial weight bearing, isthmic ratio, complications.
RESULTS
The average duration of operation for femoral fractures with reamed and unreamed nail were 104 minutes, 95 minutes, respectively. And those for tibial fractures were 96 minutes, 87 minutes, and the difference was statistically significant (p<0.05). The amount of bleeding in femoral fractures with reamed and unreamed nail were 360 ml, 223 ml, respectively. And those in tibial fractures were 280 ml, 205 ml, respectively, and the difference was statistically significant (p<0.001). The isthmic ratio in femoral fracture with reamed and unreamed nail were 105.5%, 87.0%, respectively and those in tibial fracture were 106.3%, 85.3%, respectively. There were 2 delayed unions in femoral fractures and 1 delayed union in tibial fracture with unreamed nail, and 1 metal failure in tibial fracture with unreamed nail.
CONCLUSION
Unreamed femoral intramedullary nailing involves fewer steps and less intraoperative blood loss than reamed nailing. There was no statistical difference the first time of callus formation, union time, the time of partial weight bearing. It must be consider that delayed union and metal failure in the unreamed intramedullary nailing due to high grade fracture, lower isthmic ratio, combined with multiple trauma.

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Treatment of the Femoral Shaft Fractures Using Reamed Russell-Taylor Intramedullary Nail: Shin Yoon Kim, Jun Dae Kwun, Hak Su Kim, Byung Gook Kim, Chang Wug Oh, Byung Chul Park, Joo Chul Ihn; J Korean Soc Fract 1999;12(4):824-832. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.824

Abstract PDF: The purpose of this paper was to evaluate the results of the femoral shaft fractures by reamed Russell-Taylor intramedullary nailing in the viewpoint of union time and complications. We reviewed 59 femoral shaft fractures. According to the type of fractures(Winquist-Hansen classification), average union time were 20.1 and 23.5 weeks in type 1, 2 and 3, 4, and nonunion rates were 12.5% and 10.5% in type 1, 2 and 3, 4. According to the level of fractures, average union time were 19.9, 20.3, 23.4 weeks in proximal, middle and distal fractures, and nonunion rates were 6.7%, 8.8%, 30% in proximal, middle and distal fractures. According to the reduction techniques, average union time were 20.0 and 21.5 weeks in closed and open reduction, and nonunion rates were 5.9% and 20.O% in closed and open reduction. According to the Methods of interlocking screw fixation, average union time were 19.3 and 20.7 weeks in dynamic and static fixation, and nonunion rates were 25% and 9.8% in dynamic and static fixation. There was no significant differences in averdge union time between closed and open fracture group, closed and open reduction group, and dynamic and static fixation group. There was significant differences in union time between simple and complex, comminuted fractures(P<0.05), and between distal and proximal, middle fractures(P<0.05). Also there was significant differences in nonunion rate between fracture reduced with closed and open technique(P<0.05). In conclusion, reamed Rustell-Taylor intramedullary nailing can be a uheful treatment modality in femoral shaft fracture if closed reduction is available. However, there was high complication rate including failure of screw, varut deformity, delayed union time in distal femoral shaft fractures. In this situation, we should consider other treatment method.

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Reamed versus Unreamed Intramedullary Nailing after External Fixator Application in the Treatment of Open Tibial-Shaft Fracture: Dong Bae Shin, Joon Cheol Choi, Young Soo Lee, Yong Jeng Kim, Soo Hong Han, Dong Eun Shin, Yeun Ho Lee; J Korean Soc Fract 1999;12(2):272-276. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.272

Abstract PDF: The authers reviewed 15 patients of open fracture of the tibial shaft who were treated by external fixation followed by intramedullary nailing. These fractures comprised two Type-I, two Type-II, four Type-IIIa, and seven Type-IIIb injuries. Ten patients were treated with unreamed intramedullary nailing and 5 patients were treated with reamed intramedullary nailing. The results were analyzed as followings: 1. All fractures had union at 5.2 months after intramedullary nailing and 4 true osteomyelitis were developed. 2. All osteomyelitis were developed for the patients who were treated with reamed intramedullary nailing. 3. There was no osteomyelitis who were treated with unreamed intramedullary nailing. 4. Delayed conversion to intramedullary nailing after control of pin tract infection had no effect for prevention of osteomyelitis.

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Clinical Results of Unreamed Static Interlocking Intramedullary Nailing In Clsed Tibial Shaft Fractures: Sang Yeon Lee, Young Shik Shin, Jeong Ho Yang, Heun Young Park; J Korean Soc Fract 1998;11(2):449-455. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.449

Abstract PDF: For the treatment of tibial shaft fracures interlocking intramedullary nailing has been used widely. Recently choosing between reamed or unreamed interlocking nailing for closed tibial shaft fracture is still controversial. The purpose of this study is to evaluate the results and complications of unreamed interlocking nailing for closed tibial shaft fractures. We reviewed 28 closed tibial shaft fractures that were treated with unreamed static medullary nailing from May 1993 to December 1996 at the Deparment of Orthopaedic surgery, Pohang St. Mary's Hospital. The results were as follows 1. In all 28 cases, union of the fracture was achieved at average 19.6 weeks and tere was no malunion. 2. We performed additional procedures in 4 cases(14.3%) for union : autogenous iliac bone graft in 1 case(3.5%) that was unstable segmental fracture and dynamization in 3 cases(10.7%) 3. There was breakage of distal locking screw in 1 case but no breakage of intramedullary nail.

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