Reamed Nailing of Long Bone Fractures. Is it Dangerous?

Abstract

The present study prospectively analyses 37 fractures in different long bones, correlating intramedullary pressures with the patient's clinical status, fat in peripheral blood and alterations in ventilation perfusion scans. From this study the authors recommend the use of reamed nails for the management of long bone fractures.

Key words

reamed nails - intramedullary pressure - pulmonary embolism

References

• 1 Böhler J. Closed intramedullary nailing of the femur.  Clin Orthop. 1968;  60 51-67
• 2 Boulanger B, Stephen D, Brenneman F. Thoracic trauma and early intramedullary nailing of femur fractures: Are we doing harm?.  J Trauma. 1997;  43 24-28
• 3 Bone L B, Babikian G, Stegemann P M. Femoral canal reaming in the polytrauma patient with chest injury.  Clin Orthop. 1995;  347 57-61
• 4 Bone L B, Anders M J, Rohrbacher B J. Treatment of femoral fractures in the multiply injured patient with thoracic injury.  Clin Orthop. 1998;  347 57-61
• 5 Boyer M, Ribeiro E, Hu R, Powell J. Small versus large diameter closed-section femoral nails for the treatment of femoral shaft fractures: is there a difference?.  J Trauma. 1996;  41 279
• 6 Brumback R J, Virkus W W. Intramedullary nailing of the femur: reamed versus nonreamed.  J Am Acad Orthop Surg. 2000;  8 83-90
• 7 Bucholz R W, Jones A. Current concepts review: Fractures of the shaft of the femur.  J Bone Joint Surg [Am]. 1991;  73 1561-1566
• 8 Buttaro M, Mocetti E, Alfie V, Paniego G, Piñeiro L. Fat embolism and related effects during reamed and unreamed intramedullary nailing in a pig model.  J Orthop Trauma. 2002;  16 239-244
• 9 Byrick R J, Korley R E, McKee M D, Schemitsch E H. Prolonged coma after unreamed, locked nailing of femoral shaft fracture.  Anesthesiology. 2001;  94 163-165
• 10 Christie J, Court-Brown C, Kinninmonth A. Intramedullary locking nails in the management of femoral shaft fractures.  J Bone Joint Surg [Br]. 1988;  70 206
• 11 Coles R E, Clements F M, Lardenoye J W, Wermeskerken G V, Hey L A, Nunley J A, Levin L S, Pearsall A W. Transesophageal echocardiography in quantification of emboli during femoral nailing: reamed versus unreamed techniques.  J South Orthop Assoc. 2000;  9 98-104
• 12 Clawson D K, Smith R F, Hansen S T. Closed intramedullary nailing of the femur.  J Bone Joint Surg [Am]. 1971;  53 681-692
• 13 Dominguez I. et al . Antegrade nailing of fractures of the distal femur.  Clin Orthop. 1998;  350 74-79
• 14 Giannoudis P V, Smith R M, Bellamy M C, Morrison J F, Dickson R A, Guillou P. Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures: An analysis of the second hit.  J Bone Joint Surg [Br]. 1999;  81 356-361
• 15 Giannoudis P, Pape H, Cohen A P, Krettek C, Smith R M. Review: systemic effects of femoral nailing: from Küntscher to the immune reactivity era.  Clin Orthop. 2002;  1 378-386
• 16 Hansen S T, Winquist R A. Closed intramedullary nailing of the femur. Küntscher technique with reaming.  Clin Orthop Relat Res. 1979;  138 56-61
• 17 Heim D, Regazzoni P, Tsakiris D A, Aebi T, Schlegel U, Marbert G A, Perren S M. Intramedullary nailing and pulmonary embolism: does unreamed nailing prevent embolism? An in vivo study in rabbits.  J Trauma. 1995;  38 899-906
• 18 Heltulla I, Karanko M, Gullischen E. Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures.  J Trauma. 2000;  48 704-710
• 19 Kallina CH I V, Probe R. Paradoxical fat embolism after intramedullary rodding: A case Report.  J Orthop Trauma. 2001;  15 442-445
• 20 Keating J F. The osteogenic potential of bone reaming.  Techniques in Orthopedics. 1996;  11 45-49
• 21 Kempf I, Grosse A, Beck G. Closed intramedullary nailing. Its application to comminuted fractures of the femur.  J Bone Joint Surg [Am]. 1985;  67 709-720
• 22 Kropfl A, Davies J, Berger U, Hertz H, Schlag G. Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing.  J Orthop Res. 1999;  17 261-268
• 23 Küntscher G. Fortschritte auf dem Gebiet der Marknagelung.  Arch Clin Chir. 1950;  264 547-551
• 24 López-Durán L, García López A, Durán L, Hurtado J, Ruiz C, Rodrigo J L. Cardiopulmonary and haemodynamic changes during total hip arthroplasty.  Int Orthop. 1997;  21 253-258
• 25 Orler R, Locher S, Lottenbach M, Heini P, Ganz R. Retrospective analysis of delayed unions of femoral shaft fractures treated by intramedullary nailing.  J Orthop Trauma. 2002;  16 746
• 26 Pape H C, Regel G, Dwenger A. Influence of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma.  J Trauma. 1993;  35 709-716
• 27 Pape H C, Giannoudis P V, Grimme K, van Griensven M, Krettek C. Effects of intramedullary femoral fracture fixation: what is the impact of experimental studies in regards to the clinical knowledge?.  Shock. 2002;  18 291-300
• 28 Parisi D M, Koval K, Egol K. Fat embolism syndrome.  Am J Orthop. 2002;  31 507-512
• 29 Pelias M, Townsend M, Flancbaum L. Long bone fractures predispose to pulmonary dysfunction in blunt chest trauma despite early operative fixation.  Surgery. 1992;  111 576
• 30 Pell A C, Christie J, Keating J F, Sutherland G R. The detection of fat embolism by transesophageal echocardiography during reamed intramedullary nailing: a study of 24 patients with femoral and tibial fractures.  J Bone Joint Surg [Br]. 1993;  75 921
• 31 Peltier L F. Fat embolism: an appraisal of the problem.  International Abstracts of Surgery. 1957;  104 313
• 32 Rothwell A G. Closed Küntscher nailing of femoral shaft fractures. A series of 100 consecutive patients.  J Bone Joint Surg [Br]. 1978;  60 504-509
• 33 Schemitsch E, Turchin D, Anderson G I, Byrick R, Mullen J B, Richards R R. Pulmonary and systemic fat embolism after medullary canal presurization: a haemodynamic and histologic investigation in the dog.  J Trauma. 1998;  45 738-742
• 34 Sheperd L, Shean C, Gelalis I D, Lee J, Carter V S. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: An assessment of procedures.  J Orthop Trauma. 2001;  15 28-32
• 35 Talucci R C, Manning J, Lampard S. Early intramedullary nailing of femoral shaft fractures: a cause of embolism syndrome.  Am J Surg. 1983;  146 107-111
• 36 Tornetta III  P, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing.  J Orthop Trauma. 2000;  14 15-19
• 37 Vanderveeren C, Reynders P. Healing of isolated femoral shaft fractures treated with the AO unreamed femoral nail - A comparative study with the AO reamed femoral nail.  J Bone Joint Surg [Br]. 2001;  83 215
• 38 Wenda K, Ritter G, Ahlers J, Issendorf W D. Nachweis und Effekte von Knochenmarkseinschwemmungen bei Operationen im Bereich der Femurmarkhöhle.  Unfallchirurgie. 1990;  93 56-61
• 39 Wenda K, Runkel M. Systemic complications in intramedullary nailing.  Orthopäde. 1996;  25 292-299
• 40 Weresh M J, Stover M D, Bosse M J, Jeray K, Kellam J F, Sims S H, Kline J A. Pulmonary gas exchange during intramedullary fixation of femoral shaft fractures.  J Trauma. 1999;  46 863-868
• 41 Willis B H, Carden D L, Sadasivan K K. Effect of femoral fracture and intramedullary fixation on lung capillary leak.  J Trauma. 1999;  46 687-692
• 42 Winquist R A, Hansen S T, Clawson D K. Closed intramedullary nailing. A report of five hundred and twenty cases.  J Bone Joint Surg [Am]. 1984;  66 529-539
• 43 Wolinsky P R, Sciadini M F, Parker R E, Plitman J D, Snapper J R, Rutherford E J, Schulman M, Johnson K D. Effects on pulmonary physiology of reamed femoral intramedullary nailing in an open-chest sheep model.  J Trauma. 1996;  10 75-80
• 44 Wozasek G E, Simon P, Redl H, Schlag G. Intramedullary pressure changes and fat intravasation during intramedullary nailing: an experimental study in sheep.  J Trauma. 1994;  36 202-207
• 45 Zalavras C, Shepherd L, Greene N, Gelalis I. Intramedullary pressure during reamed and unreamed femoral nailing - A prospective, randomized clinical study.  J Bone Joint Surg [Br]. 2001;  83 215-216