Shepherd, J Orthop Trauma 2001 - Prospective Randomized Study of Reamed versus Unreamed Femoral Intramedullary Nailing: An Assessment of Procedures

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Prospective Randomized Study of Reamed versus Unreamed Femoral Intramedullary Nailing: An Assessment of Procedures

Shepherd, Carter, et al.·J Orthop Trauma·2001·60 citations·RCT

Purpose

To determine whether the procedure of unreamed femoral nailing is simpler, faster, and safer than reamed femoral intramedullary nailing.

Methods

Design: Prospective randomized.

Setting and Participants: 100 femoral shaft fractures without significant concomitant injuries admitted to an academic Level 1 urban trauma center.

Intervention: Stabilization of the femoral shaft fracture using a reamed or unreamed technique.

Outcome Measures: The surgical time, estimated blood loss, fluoroscopy time, and perioperative complications were prospectively recorded.

Results

100 patients with 100 femoral shaft fractures were correctly prospectively randomized to the study.
37 patients received reamed and 63 patients received unreamed nails.
All nails were interlocked proximally and distally.
The average surgical time for the reamed nail group was 138 minutes and for unreamed nail group was 108 minutes (p = 0.012).
The estimated blood loss for the reamed nail group was 278 milliliters and for the unreamed nail group 186 milliliters (p = 0.034).
Reamed intramedullary nailing required an average of 4.72 minutes, whereas unreamed nailing required 4.29 minutes of fluoroscopy time.
7 perioperative complications occurred in the reamed nail group and 18 in the unreamed nail group.
2 patients in the unreamed group required an early secondary procedure.
Iatrogenic comminution of the fracture site occurred during 3 reamed and 6 unreamed intramedullary nailings.
Reaming of the canal was required before the successful placement of 3 nails in the unreamed group because of canal/nail diameter mismatch.

Conclusions

Unreamed femoral intramedullary nailing involves fewer steps and is significantly faster with less intraoperative blood loss than reamed intramedullary nailing. The unreamed technique, however, was associated with a higher incidence of perioperative complications, although the difference was not statistically significant (p = 0.5).

Copyright remains with the authors and publisher.

Prospective Randomized Study of Reamed versus Unreamed Femoral Intramedullary Nailing: An Assessment of Procedures

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Prospective Randomized Study of Reamed versus Unreamed Femoral Intramedullary Nailing: An Assessment of Procedures

Shepherd, Carter, et al.·J Orthop Trauma·2001·60 citations·RCT

Purpose

To determine whether the procedure of unreamed femoral nailing is simpler, faster, and safer than reamed femoral intramedullary nailing.

Methods

Design: Prospective randomized.

Setting and Participants: 100 femoral shaft fractures without significant concomitant injuries admitted to an academic Level 1 urban trauma center.

Intervention: Stabilization of the femoral shaft fracture using a reamed or unreamed technique.

Outcome Measures: The surgical time, estimated blood loss, fluoroscopy time, and perioperative complications were prospectively recorded.

Results

100 patients with 100 femoral shaft fractures were correctly prospectively randomized to the study.
37 patients received reamed and 63 patients received unreamed nails.
All nails were interlocked proximally and distally.
The average surgical time for the reamed nail group was 138 minutes and for unreamed nail group was 108 minutes (p = 0.012).
The estimated blood loss for the reamed nail group was 278 milliliters and for the unreamed nail group 186 milliliters (p = 0.034).
Reamed intramedullary nailing required an average of 4.72 minutes, whereas unreamed nailing required 4.29 minutes of fluoroscopy time.
7 perioperative complications occurred in the reamed nail group and 18 in the unreamed nail group.
2 patients in the unreamed group required an early secondary procedure.
Iatrogenic comminution of the fracture site occurred during 3 reamed and 6 unreamed intramedullary nailings.
Reaming of the canal was required before the successful placement of 3 nails in the unreamed group because of canal/nail diameter mismatch.

Conclusions

Unreamed femoral intramedullary nailing involves fewer steps and is significantly faster with less intraoperative blood loss than reamed intramedullary nailing. The unreamed technique, however, was associated with a higher incidence of perioperative complications, although the difference was not statistically significant (p = 0.5).

Copyright remains with the authors and publisher.

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