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Reamed intramedullary nailing versus unreamed intramedullary nailing for shaft fracture of femur: a systematic literature review

  • Orthopaedic Outcome Assessment
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Abstract

Introduction

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.

Methods

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.

Results

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).

Conclusion

Reamed intramedullary nailing has better treatment effects than unreamed intramedullary nailing for shaft fracture of femur in adults.

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References

  1. Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KA (2009) National data of 6409 Swedish inpatients with femoral shaft fractures: stable incidence between 1998 and 2004. Injury 40(3):304–308. doi:10.1016/j.injury.2008.07.017

    Article  PubMed  Google Scholar 

  2. Bucholz RW, Jones A (1991) Fractures of the shaft of the femur. J Bone Joint Surg Am 73(10):1561–1566

    PubMed  CAS  Google Scholar 

  3. Crist BD, Wolinsky PR (2009) Reaming does not add significant time to intramedullary nailing of diaphyseal fractures of the tibia and femur. J Trauma 67(4):727–734. doi:10.1097/TA.0b013e31819db55c

    Article  PubMed  Google Scholar 

  4. Schemitsch EH, Kowalski MJ, Swiontkowski MF, Harrington RM (1995) Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia. J Orthop Res 13(3):382–389. doi:10.1002/jor.1100130312

    Article  PubMed  CAS  Google Scholar 

  5. Leunig M, Hertel R (1996) Thermal necrosis after tibial reaming for intramedullary nail fixation. A report of three cases. J Bone Joint Surg Br 78(4):584–587

    PubMed  CAS  Google Scholar 

  6. Wenda K, Runkel M, Degreif J, Ritter G (1993) Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing—demonstrated by intraoperative echocardiography. Injury 24(Suppl 3):S73–S81

    Article  PubMed  Google Scholar 

  7. Reynders PA, Broos PL (2000) Healing of closed femoral shaft fractures treated with the AO unreamed femoral nail. A comparative study with the AO reamed femoral nail. Injury 31(5):367–371

    Article  PubMed  CAS  Google Scholar 

  8. Moed BR, Watson JT, Cramer KE, Karges DE, Teefey JS (1998) Unreamed retrograde intramedullary nailing of fractures of the femoral shaft. J Orthop Trauma 12(5):334–342

    Article  PubMed  CAS  Google Scholar 

  9. Pfister U (2010) Reamed intramedullary nailing. Orthopade 39(2):171–181

    Article  PubMed  CAS  Google Scholar 

  10. Higgins JP, Green S (2009) Cochrane handbook for systematic reviews of interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration. http://www.cochrane-handbook.org. Accessed 14 March 2011

  11. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. doi:10.1136/bmj.327.7414.557

    Article  PubMed  Google Scholar 

  12. Tornetta P 3rd, Tiburzi D (1997) The treatment of femoral shaft fractures using intramedullary interlocked nails with and without intramedullary reaming: a preliminary report. J Orthopaed Trauma 11(2):89–92

    Article  Google Scholar 

  13. Clatworthy MG, Clark DI, Gray DH, Hardy AE (1998) Reamed versus unreamed femoral nails. A randomised, prospective trial. J Bone Joint Surg Br 80(3):485–489

    Article  PubMed  CAS  Google Scholar 

  14. Selvakumar K, Saw KY, Fathima M (2001) Comparison study between reamed and unreamed nailing of closed femoral fractures. Med J Malaysia 56(Suppl D):24–28

    PubMed  Google Scholar 

  15. Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS (2001) Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures. J Orthop Trauma 15(1):28–32 discussion 32–33

    Article  PubMed  CAS  Google Scholar 

  16. Canadian Orthopaedic Trauma Society (2003) Nonunion following intramedullary nailing of the femur with and without reaming: results of a multicenter randomized clinical trial. J Bone Joint Surg Ser A 85(11):2093–2096

    Google Scholar 

  17. Anwar IA, Battistella FD, Neiman R, Olson SA, Chapman MW, Moehring HD (2004) Femur fractures and lung complications: a prospective randomized study of reaming. Clin Orthop Relat Res (422):71–76

  18. Canadian Orthopaedic Trauma Society (2006) Reamed versus unreamed intramedullary nailing of the femur: Comparison of the rate of ARDS in multiple injured patients. J Orthop Trauma 20(6):384–387

    Article  Google Scholar 

  19. Roberts C, Torgerson D (1998) Randomisation methods in controlled trials. BMJ 317(7168):1301

    PubMed  CAS  Google Scholar 

  20. Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 273(5):408–412

    Article  PubMed  CAS  Google Scholar 

  21. Schulz KF, Chalmers I, Altman DG (2002) The landscape and lexicon of blinding in randomized trials. Ann Intern Med 136(3):254–259

    PubMed  Google Scholar 

  22. Sackett DL RW, Rosenberg W, Haynes RB (1997) Evidence-based medicine: how to practice and teach EBM, 1st edn. Churchill Livingstone, New York

    Google Scholar 

  23. Moher D, Schulz KF, Altman D (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 285(15):1987–1991. doi:jsc00437

    Article  PubMed  CAS  Google Scholar 

  24. Giannoudis PV, Tzioupis C, Pape HC (2006) Fat embolism: the reaming controversy. Injury 37(Suppl 4):S50–S58. doi:10.1016/j.injury.2006.08.040

    Article  PubMed  Google Scholar 

  25. Klein MP, Rahn BA, Frigg R, Kessler S, Perren SM (1990) Reaming versus non-reaming in medullary nailing: interference with cortical circulation of the canine tibia. Arch Orthop Trauma Surg 109(6):314–316

    Article  PubMed  CAS  Google Scholar 

  26. Weninger P, Figl M, Spitaler R, Mauritz W, Hertz H (2007) Early unreamed intramedullary nailing of femoral fractures is safe in patients with severe thoracic trauma. J Trauma 62(3):692–696. doi:10.1097/01.ta.0000243203.38466.e0

    Article  PubMed  Google Scholar 

  27. Saldua NS, Kuhn KM, Mazurek MT (2008) Thermal necrosis complicating reamed intramedullary nailing of a closed tibial diaphysis fracture: a case report. J Orthop Trauma 22(10):737–741. doi:10.1097/BOT.0b013e31818ccddf

    Article  PubMed  Google Scholar 

  28. Forster MC, Aster AS, Ahmed S (2005) Reaming during anterograde femoral nailing: is it worth it? Injury 36(3):445–449. doi:10.1016/j.injury.2004.07.031

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Natrual Science Foundation of China, No:30973049.

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Authors and Affiliations

  1. Department of Orthopedics, West China Hospital, Sichuan University, No 37 Guo Xue Xiang, Chengdu, 610041, China

    Xin Duan, Tao Li, Al-Qwbani Mohammed & Zhou Xiang

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  1. Xin Duan
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  2. Tao Li
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  4. Zhou Xiang
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Correspondence to Zhou Xiang.

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Duan, X., Li, T., Mohammed, AQ. et al. Reamed intramedullary nailing versus unreamed intramedullary nailing for shaft fracture of femur: a systematic literature review. Arch Orthop Trauma Surg 131, 1445–1452 (2011). https://doi.org/10.1007/s00402-011-1311-8

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