This 2007 JAAOS review covers the biomechanical principles and biological effects of intramedullary nailing for lower extremity long-bone fractures, synthesizing how nail design, reaming technique, and locking screw strategy interact to determine fixation stability and fracture healing.
When selecting nail diameter and deciding whether to ream, remember that reaming's short-term vascular cost is real but transient, while its mechanical and biological gains — larger nail, more cortical contact, extraosseous blood flow stimulation — are durable; reserve unreamed nailing for specific situations (damage control, select open fractures) rather than routine use.
When you see a proximal femur fracture being nailed and the starting point drifts anterior, recognize that ≥6 mm of anterior malposition is a threshold for intraoperative bursting fracture from hoop stress.
This 2007 JAAOS review covers the biomechanical principles and biological effects of intramedullary nailing for lower extremity long-bone fractures, synthesizing how nail design, reaming technique, and locking screw strategy interact to determine fixation stability and fracture healing.
When selecting nail diameter and deciding whether to ream, remember that reaming's short-term vascular cost is real but transient, while its mechanical and biological gains — larger nail, more cortical contact, extraosseous blood flow stimulation — are durable; reserve unreamed nailing for specific situations (damage control, select open fractures) rather than routine use.
When you see a proximal femur fracture being nailed and the starting point drifts anterior, recognize that ≥6 mm of anterior malposition is a threshold for intraoperative bursting fracture from hoop stress.