Reamed vs Unreamed IM Nails - Roland Russell 17/2/2004h1 style="MARGIN: 0cm 0cm 0pt"> Medline search of ‘ reamed versus unreamed nails’ revealed 12 papers.
1)Effect of acute reamed versus undreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures: a randomised prospective study
Nassif JM, Gorczyca JT, Cole JK, Pugh KJ, Pienkowski D
Division of Orthopaedics ,
48 Adults with 49 #s nailed within 3 days of #s
compartment pressure monitored postoperatively in anterior and deep posterior compartment pressures
peak pressure obtained during reaming in reamed group and nail placement in the unreamed group
no patients got compartment syndrome and peak pressures were in fact higher in the unreamed
group
4 prospective randomised studies
1) Prospective randomised study of reamed versus unreamed femoral
intramedullary nailing; an assessment of procedures
Shephard LE, Shean CJ, Gelais ID, Lee J, Carter VS
J Orthopaedic Trauma 2001 Aug
Supports use of undreamed( easier , less blood loss) but does not look at union
2) Prospective randomised study of reamed versus unreamed femoral intramedullary nailing : an assessment of procedures
Gopal S, Giannoudis PV
3) Reamed or unreamed Nailing For Closed Tibial Fractures
A Prospective Study in Tscherne C1 Fractures
C.M Court-Brown, J Christie, M Mcqueen Royal Infirmary of
JBJS(BR) VOL 78 No 4 JULY 1996
Jan 1993-Jan 1994, Prospective, randomised trial.
METHOD
50 patients with Tscherne C1 tibial diaphyseal fractures
reamed Grosse-Kempf tibial nail VS undreamed AO UTN nail
Randomised using prefilled envelopes
Reamed nails-at least 11mm-inserted using standardised technique of Court-Brown
Unreamed at least 8 or 9 mm in diameter-inserted according manufacturers instruction
1.5g cefuroxime at induction + 8 and 16 hours postop
Compartment pressure monitoring all patients
Reamed Group
Unreamed Group
Mean Age
35 years
36.1 years
% Males
78%
68%
AO Type A#
23
30
Similar postoperative regime. All followed up for one year in a research clinic.
Research physiotherapist assessed time to union, malunion, infection, further surgery and anterior knee pain.
Mobility of
knee, ankle, and subtalar joints assessed 3,6 and 12 months
Time to return to work noted
Union=x-ray+Court-Brown clinical criteria
Malunion=>5 degrees of angular or rotary malalignment
Or > 1cm leg length discrepancy
Exchange nailing performed if atrophic union at 12 to 14 weeks or persistant hypertrophic non-union
Stats: Mann Whitney- difference in union
Fisher’s difference in requirement for second operation
RESULTS
REAMED
UNREAMED
MEAN UNION
15.4 WEEKS
22.8 WEEKS
P<0.01
(11 TO 25)
(12 TO 36)
significant
Exchange Nailing
0
5 patients
p=0.05
Malunion
0
4 patients
Mechanical Failure
1
Screw breakage
13 Screw Breakage
0 nail Breakage
1 Broken Nail
Compartment Synd
2
3
Return to Work
10.9
9.3 ( NOT SIG)
Incidence of knee pain
60%
54%
No significant difference between mobility of knee ankle and subtalar joints
DISCUSSION
Unreamed nail compared to reamed for Tscherne C1 tibial diaphyseal #:-
1 prolonged time to union
2 notable incidence of non-union
3 increased exchange nailing-although p value not quite significant
This paper supports the use of reamed nailing.
CRITIQUE
1)
50 Patients- perhaps more required
2)
? grosse-kempf nail and undreamed AO nail comparable
3)
prospective, randomised
4)
? same surgeon, if not ? comparable grade
5)
significant increase time in union for undreamed group
Reamed Versus Nonreamed Anterograde Femoral Nailing
Tornetta, Paul III; Tiburzi, Douglas
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