Abstract
At our clinic an average of about 70 to 90 diaphyseal fractures a year are treated
primarily by unreamed intramedullary nailing (UHN, UFN and UTN). In a study of all
fractures of the lower leg from 1988-1990 we found in 106 reamed intramedullary nailed
fractures only 3 cases of non union (2 × secondary, one primary operation) which is
in accordance with the results in the literature. Now with the use of unreamed intramedullary
nailing according to our feeling we seem to observe an increased number of delayed
unions or non-unions. To clarify this we recorded all patients (n = 71) treated at
our clinic with a URN (total fractures: 78; UHN: 12, UFN: 27, UTN: 39) between July
2000 and June 2001 prospectively. Additionally, we have been analysing the operations
of delayed fracture healing carried out in the same space of time (n = 22; humerus:
4, femur: 3 and tibia: 15). Overall, we found a slight tendency for higher rates of
disturbed fracture healing in tibial fractures, which is similar to the results in
the literature. As a result we do not see the necessity to change therapeutic regime
for humerus and femur while for the tibia we claim a critical regard of indication
and we discuss alternative therapeutic measures (reamed nailing, LISS). Due to the
evident advantages of the treatment of open fractures unreamed nailing of the tibia
should be maintained.
Key words
Unreamed nail - disturbed fracture healing - non union - delayed union
