Reamed intramedullary nailing is the current gold standard for the treatment of diaphyseal fractures of the femur and tibia. Current concepts of orthopedic damage control surgery for patients with multiple injuries have placed an emphasis on appropriate surgical timing, limiting blood loss, and the duration of the initial operative procedure(s). Proponents of unreamed nailing have stated that reaming places polytraumatized patients "at risk," in part because it adds to the length of the surgical procedure and may exacerbate the severity of a patient's pulmonary injury. The purpose of this study was to determine how many minutes reaming actually takes and what percentage of operative time reaming comprises during intramedullary nailing of femoral and tibial shaft fractures.
Intraoperative timing data were collected prospectively on a total of 52 patients with 54 fractures (21 femoral and 33 tibial) who underwent reamed intramedullary nailing of acute closed or open femoral or tibial shaft fractures over a 10-month period. Total operating room, surgical, and reaming times were collected.
The average reaming time for femur and tibia fractures was 6.9 minutes and 7 minutes, respectively. On average, reaming accounted for 4.9% of the surgical time and 3.2% of the total operating room time for femur fractures and 4.9% of the surgical time and 3.4% of the total operating room for tibia fractures.
Our results show that reaming comprises a small percentage of the operative time and the total time a patient spends in the operating room.
"Different open and close techniques have been described for using this device and each may be preferred by some surgeons according to availability of operating room equipment (such as C-arm and fracture table), patient's factor (such, as morbid obesity), and fracture pattern and associated injuries (i.e., floating knee injury, concomitant acetabular fracture, and spinal injury). According to the majority of studies ream intramedullary technique is the preferred method and has a greater chance of healing and lower rate of complications with regard to unreamed technique. From the early papers until now, there are still controversies in results of femoral shaft fractures treated by close versus open IMN. "
[Show abstract][Hide abstract] ABSTRACT: Background:Femoral shaft fractures are among the most common fractures following high trauma injuries. Different kinds of treatment have been suggested for these injuries.Aim:The aim of this study was to compare the results femoral fractures treated by mini open and close intramedullary nailing (IMN) technique.Materials and Methods:A total of 48 adult patients were operated due to fracture of the femur with close or open IMN technique between September 2010 and September 2011. 23 patients operated with close. IMN technique was included in Group I while 24 patients operated with mini open IMN technique constituted Group II. In Group I, all patients. Were operated on the fracture table in the supine position while in Group II, all patients underwent surgery on standard tables in the lateral position.Results:The mean age of patients was 27.3 years, ranging between 16 and 62. The mean age of the close nailing and open nailing groups was 30.5 and 24.5 respectively (P = 0.052). Only one patient from the open nailing group failed to unite. The mean time for union in close and open nailing groups was 13 + 2.4 and 17.7 + 2.3 weeks respectively (P = 0.001). No infection or limb length discrepancies were observed in the two groups.Conclusion:Although close nailing is the preferred methods in most cases, but in poly-traumatized patients or in centers where there are no fracture tables or C-arm, open nailing is a good option.
[Show abstract][Hide abstract] ABSTRACT: Fractures of femoral fracture are among the most common fractures encountered in orthopedic practice. Intramedullary nailing is the treatment choice for femoral shaft fractures in adults. The objective of this article is to determine the effects of reamed intramedullary nailing versus unreamed intramedullary nailing for fracture of femoral shaft in adults.
Cochrane Central Register of Controlled Trials (October 2010), PubMed (October 2010) and EMBASE (October 2010) were searched. Randomized and quasi-randomized controlled clinical trials were included. After independent study selection by two authors, data were collected and extracted independently. The methodological quality of the studies was assessed. Pooling of data was undertaken where appropriate.
Seven trials with 952 patients (965 fractures) were included. Compared with unreamed nailing, reamed nailing was significantly lower reoperation rate (RR 0.25, 95% CI 0.11-0.59, P = 0.002), lower non-union rate (RR 0.20, 95% CI 0.05-0.77, P = 0.02) and lower delay union rate(RR 0.30, 95% CI 0.14-0.64, P = 0.002). There was no significant difference when comparing reamed nailing with unreamed nailing for implant failure (RR 0.51, 95% CI 0.16-1.61, P = 0.25), mortality(RR 0.94, 95% CI 0.19-4.58, P = 0.94) and acute respiratory distress syndrome(RR 1.53, 95% CI 0.37-6.29, P = 0.55). Unreamed nailing was significantly less blood loss (SMD 119.23, 95% CI 59.04-180.43, P = 0.0001).
Reamed intramedullary nailing has better treatment effects than unreamed intramedullary nailing for shaft fracture of femur in adults.
Archives of Orthopaedic and Trauma Surgery 05/2011; 131(10):1445-52. DOI:10.1007/s00402-011-1311-8 · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction:
This level II prospective study investigates patient and fracture-related factors likely to affect closed reduction time in the surgical treatment of femur fractures, and the effect these factors have on closed reduction time.
Patients and methods:
Seventy-nine diaphyseal femur fractures of 75 patients were included in the present study. All fractures were treated with indirect closed reduction by manual traction using antegrade nailing and static, locked, reamed intramedullary nails. The three variables considered to influence the duration of closed reduction, that is, the type of fracture, BMI, and the preoperative period (time from injury to surgery), were evaluated either separately or in a combination of two or three of the variables. Their influence on the closed reduction time was analyzed and evaluated.
In this study according to the outcomes, a preoperative period ≤24 h had a significant effect in shortening the reduction time. The reduction time was not significantly affected by the type of fracture. The reduction time was prolonged in overweight patients, but the difference was not significant. When the three variables BMI, preoperative period, and fracture types were evaluated together, the common effect of these three variables was not significant.
In conclusion, based on these results, we think that closed reduction should certainly be aimed for in femur fractures in which intramedullary nailing is planned. Also, early surgical intervention appears to have a beneficial effect on the success of closed reduction.
European Journal of Orthopaedic Surgery & Traumatology 10/2012; 23(8). DOI:10.1007/s00590-012-1107-8 · 0.18 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.