The Unreamed Intramedullary Nail - Is There an Increased Rate of Disturbed Fracture Healing?

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