Animal models to assess the local and systemic effects of nailing: review of the literature and considerations for future studies.

Abstract

Numerous experimental studies have been performed to investigate the adverse effects of reamed versus unreamed nailing in isolated or combined trauma models. However, the translational relevance is still discussed controversially. A systemic review of the literature was performed. An increase of intramedullary pressure with liberation of emboli to the venous and systemic circulation associated with reamed and unreamed nailing has been well described. Reamed nailing, however, seems to have superior clinical results in terms of fracture healing. The pathophysiologic effects, optimal timing, and technique of reamed nailing particularly in patients with multiple injuries continue to be controversial topics. Therefore, further experimental studies should focus on these topics as well as on the interaction of local and systemic processes particularly in the context of different surgical treatment strategies (Early Total Care vs. Damage Control Orthopaedics) to improve our understanding and approach to intramedullary nailing.