Unreamed Nailing Research Articles

Primary dynamic interlocking nail in femoral shaft fracture: A case series

Introduction and importanceFemoral shaft fracture is one of the most frequent injuries encountered by an orthopedic surgeon. Surgical treatment is commonly needed. Intramedullary nailing remains the gold-standard in surgical treatment of femoral shaft fracture. One of the constant dilemmas in intramedullary nailing is whether to use a static or dynamic locking screw for treating femoral shaft fractures. Case presentationWe reported three cases of simple femoral shaft fracture and surgically fixed with primary dynamic interlocking nail. Closed reduction with reamed nail was performed in 2 cases, and mini open reduction with un-reamed nail was performed to the other one. Early weight bearing was instructed at day 1 post-operative. Mean follow-up period was 12.6 months. A solid bony union was achieved by all patients, and no complications were observed at the final follow up. Clinical discussionIntramedullary nailing can be made static or dynamic. It is thought that in static mode of the intramedullary nailing, the axial weight is transferred through the locking screws rather than the fracture site, thus altering the callus formation and delaying fracture healing. A prompt dynamization of the fragments allows the contact of both fragments during mobilization and promotes early callus formation. ConclusionPrimary dynamic interlocking nail is an effective option for surgical treatment in simple or short oblique femoral shaft fracture.

What's New in Orthopaedic Trauma.

What's New in Orthopaedic Trauma.

Callus cap over a Küntscher nail: A case report and literature review for heterotrophic ossification

Introduction: Intramedullary Nailing (IMN) has been the gold standard treatment for femoral shaft fractures. Earlier it was managed by Küntscher nail (K nail) fixation. However, in developing countries K nail may still be used as a low-cost fixation device. Heterotrophic Ossification (HO) is a rare complication following nailing in the treatment of femoral shaft fractures. HO along the K nail presenting with late symptomatology have been discussed rarely. Case report: A 43-year old male presented with a symptomatic callus cap along the proximal end of a left sided femoral K nail. He developed severe pain after a prolonged duration approximating around twenty years of the primary femoral fixation. The hip joint pain intensified with significant limitation affecting daily routine activities. Excision of the smooth contoured callus cap along with the removal of nail was done. The hip function recovered with painless full range of hip motion. There was no evidence of recurrence noted at a twoyear follow-up. Discussion: The smooth contour of the cap correlated to a persisting HO around the protruding end of K nail with no initial symptoms. The compressive and pressure symptoms along with the callus cap encroachment now contributes to the painful symptoms. The late symptomatology may reasonably be attributed to either impingement or abutment of the callus cap along the pelvic wall. Conclusion: K nail is an uncommon fixation device for femoral fracture fixation. HO following K nail being another uncommon infrequent complication. The symptomatic acquired HO should be considered for excision to preserve the hip joint function and maintain the ability to do activities of daily living. Keywords: callus cap; heterotrophic ossification; un-reamed nailing; femur fracture; küntscher nail. Abbreviations: IMN: Intramedullary Nail; HO: Heterotrophic Ossification; K-nail: Küntscher Nail.

Early myocardial damage (EMD) and valvular dysfunction after femur fracture in pigs

Musculoskeletal injuries are the most common reason for surgery in severely injured patients. In addition to direct cardiac damage after physical trauma, there is rising evidence that trauma induces secondary cardiac structural and functional damage. Previous research associates hip fractures with the appearance of coronary heart disease: As 25% of elderly patients developed a major adverse cardiac event after hip fracture. 20 male pigs underwent femur fracture with operative stabilization via nailing (unreamed, reamed, RIA I and a new RIA II; each group n = 5). Blood samples were collected 6 h after trauma and the concentration of troponin I and heart-type fatty acid binding protein (HFABP) as biomarkers for EMD were measured. At baseline and 6 h after trauma, transesophageal ECHO (TOE) was performed; and invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after femur fracture. A systemic elevation of troponin I and HFABP indicate an early myocardial damage after femur fracture in pigs. Furthermore, various changes in systolic (ejection fraction and cardiac output) and diastolic (left ventricular end-diastolic pressure, mitral valve deceleration time and E/A ratio) parameters illustrate the functional impairment of the heart. These findings were accompanied by the development of valvular dysfunction (pulmonary and tricuspid valve). To the best of our knowledge, we described for the first time the development of functional impairment of the heart in the context of EMD after long bone fracture in pigs. Next to troponin and HFABP elevation, alterations in the systolic and diastolic function occurred and were accompanied by pulmonary and tricuspid valvular insufficiency. Regarding EMD, none of the fracture stabilization techniques (unreamed nailing, reaming, RIA I and RIA II) was superior.

Are the unreamed nails indicated in diaphyseal fractures of the lower extremity? A biomechanical study

IntroductionIntramedullary nailing is generally accepted as the first choice for the treatment of diaphyseal fractures of femur and tibia, with a gradual incease in the use of unreamed nails. Different studies during last years show controversial outcomes. Some authors strongly favor unreamed nailing, but most of the authors conclude that reamed nailing have proved to be more successful. Material and methodsThis study simulates unreamed intramedullary nailing of four femoral and three tibial fracture types by means of Finite Element (FE) models, at early postoperative stages with a fraction of physiological loads, in order to determine whether sufficient stability is achieved, and if the extent of movements and strains at the fracture site may preclude proper consolidation. ResultsThe behavior observed in the different fracture models is very diverse. In the new biomechanical situation, loads are only transmitted through the intramedullary nail. Mean relative displacement values of fractures in the femoral bone range from 0.30 mm to 0.82 mm, depending on the fracture type. Mean relative displacement values of the tibial fractures lie between 0.18 and 0.62 mm, depending on the type of fracture. Concerning mean strains, for femoral fractures the maximum strains ranged between 12.7% and 42.3%. For tibial fractures the maximum strains ranged between 10.9% and 40.8%. ConclusionsThe results showed that unreamed nailing provides a very limited mechanical stability, taking into account that analyzed fracture patterns correspond to simple fracture without comminution. Therefore, unreamed nailing is not a correct indication in femoral fractures and should be an exceptional indication in open tibial fractures produced by high-energy mechanism.

Reunion of post nail aseptic non-union of diaphyseal femoral fractures by augmentation plating, decortication and bone grafting - Replacement for exchange nailing.

The aim is to re-unite post nail aseptic non-union of diaphyseal femoral fractures in an economical and safe way with almost certainty, reducing dependence on others with early rehabilitation. The cascade of fracture healing is dependent on mechanical stability and uninterrupted cellular and bio-chemical responses (biology). Intra-medullary nailing in fresh diaphyseal femoral fractures is gold standard treatment with high success rate, still non-union of these fractures is reported, though the incidence has declined considerably. This prospective study conducted at level one trauma centre on twenty-one patients in four years starting from July 2015 to June 2019. Eighteen patients had non-union with intact implant and three had broken nail. Non-union site approached through lateral approach. Non-union site fixed by 4.5 broad combi-hole LCP or distal femoral locking compression plate (DF-LCP) depending on fracture site. Decortication, Bone grafting done retaining the previous nail in situ in eighteen patients and in three patients, broken nail was exchanged with same size of unreamed nail and then, similar procedure carried out. All non-unions in 21 patients reunited without any complications. All patients regained painless unsupported walk. The most preferred treatment for this complex non-union is reamed exchanged nailing. Larger nail increases mechanical stability by better frictional contact with surrounding bone in isthumic fracture but fails in cases of fractures with comminution, spacious distal fragment and fracture with small distal fragment. Various studies reported success rate in reamed exchange nailing from 53-96% with an average 74%. The main cause of instability is rotational stress which is completely obliterated by augmentation plating and various studies report 100% success. Augmentation plate with retained nail increases stiffness and strength of construct. Concomitant decortication and cancellous bone graft stimulates osteogenesis. It is a simple, safe and economical procedure, correcting and providing both mechanical and biological environments to convert non-union into osseous union. It will be a treatment of choice in times to come.

Protective effects of new femoral reaming techniques (Reamer irrigator aspirator, RIA I and II) on pulmonary function and posttraumatic contusion (CT morphology) – results from a standardized large animal model

IntroductionThe effects of reaming for preparation of intramedullary fixation in long bone fractures have been widely studied. We compared pulmonary and systemic effects between conventional reaming with reamer irrigator aspirator and unreamed nailing in an acute porcine trauma model with a standardized femur fracture. Materials and MethodsIn a standardized porcine model, (moderate blunt chest trauma, abdominal injury and femoral shaft fracture), the femur was submitted to intramedullary nailing after resuscitation and normalization of pulmonary function. The treatment groups included 3 reamer types (Group RFN: conventional reaming with Synream; group RIA1; reamer irrigator aspirator, version 2005; group RIA 2; reamer irrigator aspirator, version 2019) and were compared to unreamed femoral nailing (Group UFN). Pulmonary function measurements included arterial partial carbon-dioxide pressure (paCO2 [kPa]) (baseline, post reaming, 2,4,6 h) and volumetric measures of contusion in chest computer tomography (CT) (at 6 hrs.). Systemic inflammatory response was measured at baseline and every second hour until six hours after trauma. ResultsThis study included 24 male animals, mean weight 50.76 ± 4.1 kg n = 6 per group). Group RFN developed a significantly higher partial CO2 (pCO2) at one hour after reaming when compared with all other groups (7.4 ± 0.4 kPa versus 5.4 ± 0.6 RIA 1, 5.6 ± 0.4 RIA 2, and 5.5 ± 0.5 UFN, p < 0.001), along with a had lower pO2 (12.3 ± 1.3 kPa versus 17.2 ± 1.9 RIA 1, 17.4 ± 1.6 RIA 2, and 16.4 ± 0.7 UFN, p < 0.001) and the degree of pulmonary hyperdense changes in the CT analysis was higher in RFN (485.2 ± 98.5 cm3 versus 344.4 ± 74.4 cm3 RIA 1 and 335.2 ± 58.1 cm3 RIA 2, p < 0.01). The inflammatory reaction was lowest in both RIA groups when compared with group RFN or UFN (p < 0.001). ConclusionBoth RIA 1 and RIA 2 protect the lung from reaming induced dysfunction and have no systemic inflammatory effects, while the negative effects were more sustained after reamed or unreamed nailing. Both RIA 1 and RIA II appear to be of value in terms of a Safe Definitive Surgery (SDS) strategy.

Comparative study on intramedullary nailing versus AO external fixation in the management of gustilo type II, IIIA, and IIIB tibial shaft fractures.

Objectives: To compare the external fixator and unreamed interlocking nail in treating Gustilo type II, type IIIA, and type IIIB tibial diaphyseal fractures regarding complications. Study Design: Cross-Sectional and Comparative Study. Setting: Department of Orthopaedic Surgery and Traumatology (DOST) Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad. Period: Two years February 2016 to January 2018. Material &amp; Methods: 40 cases of open tibia fractures in Patients of Gustilo type II, type IIIA, and type IIIB tibial diaphyseal fractures were included. The data were analyzed using the statistical program SPSS version 16.0. Results: A total of 23 cases were treated by external fixator and 22 cases were treated by unreamed solid interlocking nail. A total of 14 cases, that is, 31% showed delayed union. Type II injury 3/15 = 20%; Type IIIA injury 6/22 = 27.3%; Type IIIB injury it is -5/8 = 12.5%. For cases treated with unreamed nail, it was 22.7%; external fixator was 39.1% among 45 cases, 05 cases showed nonunion. For cases treated with unreamed nail, it was 13.6%; external fixation was 8.7%. The overall rate of eep infection is 11.1%. The rate in interlocking nail was 13.6%, and external fixation was 8.7%. Reoperation in the form of dynamization and bone graft application after 20 weeks in unreamed nail was 36.4%, whereas in external fixation the rate was high, almost 48%. The average time of union with unreamed interlocking was about 25.4 weeks, wherein external fixation it was 28.6 weeks. Conclusion: External fixators are a good and reliable method of stabilization of Gustilo type II, type IIIA, and type IIIB tibial diaphyseal fractures, unreamed interlocking intramedullary nail yields better results in treating Gustilo type II and type IIIA tibial shaft fractures.

Management of humeral impending or pathological fractures with intramedullary nailing: reaming versus non reaming technique-a retrospective comparative study.

To compare reamed intramedullary nailing (RIM) versus un-reamed intramedullary nailing (URIM) for the treatment of impending and pathological fractures of the humeral shaft in terms of 24-h postoperative pain, blood transfusion requirements, surgical time, surgical complications, medical complications, length of stay and consolidation rates. A retrospective comparative study between January 2013 and December 2018 was conducted. Student's t test, Mann-Whitney U and Chi-square tests were used to detect differences within the two study groups. Multiple linear regression was done to adjust for possible confounders. A total of 53 patients (33 RIM vs. 20 URIM) underwent humeral nailing. Fifteen (28%) were impending fractures (7 RIM vs. 8 URIM). Multiple myeloma (49%) and metastatic carcinoma (39.6%) were the most common etiologies. Pain score (5.13 ± 0.68 RIM vs. 6.78 ± 0.62 URIM; p = 0.082) and total dose of opioids (33.125 ± 27.6 RIM vs. 33.3 ± 22.28 URIM; p = 0.462) showed similar results. Blood transfusion was more prevalent within RIM group (34.48% RIM vs. 20% URIM; p = 0.044) with a clinical tendency of higher blood loss (207.86 ± 150.83RIM vs. 127.00 ± 179.98 URIM; p = 0.092). There was a consolidation rate of 71.05% (27/38) with no statistical difference (73.08% (19/26) RIM vs. 66.67% (8/12) URIM; p = 0.685). Our study suggests possible benefit of URIM in terms of less blood transfusions with no difference in consolidation rates. Even though without significance, a tendency to less blood loss, less events of systemic complication and lower length of stay was observed with URIM. Despite its limitations, this study can be used to design future prospective ventures that quantify patient-reported outcomes and provide more clear evidence.

Interlocking Tibial Nail in open Tibial Fracture

ABSTRACTPurpose : To assess the clinical outcome of intramedullary interlocking nailing in open fractures of tibia, and to evaluate the incidence of complications in these open fractures as a result of the intramedullary nailing.METHODS: Between FEB 2018 and feb 2019, a total of 15 cases of open tibial shaft fractures were operated on with unreamed interlocking nails at zagazig university hospital, (6 females and 9 males) were available for study All fractures were classified according to Gustilo and Anderson system for open fractures. There were 9 (60%) type-I, 5 (33.3%) type-II,1 (6.7%) type-IIIA, . After thorough debridement under anesthesia, an interlocking nail was inserted. All nails were statically locked with two screw each proximally and distally.RESULTS: The patients were followed up for a mean period of 12 months (range, 6-12 months) and union time were evaluated according to the R.U.S.T score Results were good to excellent Rust score was distributed as 11.26±0.96 with minimum 9 and maximum 12 which refers to full union . Of all 15 patient 8 cases (53.6%) were with no complication and Superficial wound infection was (13.3%) as Ankle stiffness 1 case (6.7%), Delayed union 1 case (6.7%) and anterior Knee pain were 3 patient with (20.1%).CONCLUSION: This study demonstrates that grade I, II and III A open tibial shaft fractures can be treated with primary debridement and locked unreamed intramedullary nailing with good short-term results, a better biomechanical stability and early rehabilitations and infection rates as compared to other methods.

PRIMARY UNREAMED NAILING IN GRADE I, II AND IIIA OPEN FRACTURES OF THE TIBIA SHAFT: A PROSPECTIVE STUDY OF THE OUTCOMES IN 80 PATIENTS

Introduction. To evaluate the incidences of union, nonunion and infection in the treatment of open tibial shaft fractures of Gustilo–Anderson types I, and IIIA treated with primary unreamed solid intramedullary locked nail (UTN). Materials and Methods. It is a prospective study of 80 open tibial shaft fractures. According to the AO classification, 36 patients (44%) were of type A, 29 (36%) were of type B and 15 (18%) were of type C. According to the Gustilo–Anderson classification, 31 patients (38.7%) were of grade I, 24 (30%) were of grade II and 25 (31%) were of grade IIIA. For the definitive stabilization of the fracture was used a UTN. Results. Bone healing was achieved in 98.4% of the cases, with a mean time of 24.2 weeks, ranging from 14 weeks to 110 weeks. Union without infection was seen in 70 patients (87%) and nonunion was seen in five patients (6%). Deep infection was seen in three patients (3.7%) and malunion was seen in two patients (2.5%). Conclusion. The treatment of open tibial shaft fractures with unreamed solid intramedullary locked nail allows high rates of bone healing and low rates of nonunion and deep infection, and if the presence of infection is excluded, then the results of unreamed nailing and reamed nailing are the same.

Outcome analysis of interlocking nailing for tibial shaft fractures

The results of closed intramedullary nailing technique are excellent for treating fractures of the tibial shaft. We decided to analyse the outcome of primary interlocking nailing done for tibial fractures. All patients with tibial shaft fractures treated with primary interlocking nail were evaluated. Static or dynamic locking was done depending upon the fracture pattern and stability. 44 fractures were included in the study. Reaming was done in 41 (93%) patients rest of them being unreamed nailing for compound fractures. Nine (20%) of the nails were dynamically locked. 95.6% united uneventfully except two (4.4%). The average time to union was 26 weeks. Primary Interlocking nailing for tibial shaft fractures is an excellent method of definite surgical management of closed and compound fractures of tibia. Interlocking nailing has less chance of complications like infection and non union as expected in compound injuries with bone loss. It is more acceptable to patients than external fixators in these scenarios.

Functional outcome of primary unreamed interlocking intramedullary nailing in open tibial fractures

Background & Objectives: Open tibial fracture management is a major challenge to orthopedic surgeons globally. Successful treatment of open tibial fractures aims at bony union’ soft tissue healing and functional improvement to premorbid state. The management protocol for open tibial fracture still remains to be controversial as there is difference in opinion regarding type of implant and method of surgery (reamed or unreamed). Soft tissue injury because of high energy injury and infection makes treatment more challenging. The aim of our study was to evaluate the functional outcome of primary undreamed interlocking intramedullary nailing in open tibial fractures. Materials & Methods: 50 patients presenting to casualty, Govt. Medical College, Kozhikode between Januvary2015-March 2016 with open tibial fractures in the age group 18- 60 amenable to ILN was selected. All patients were treated with thorough wound debridement and skeletal stabilization with undreamed interlocking nail in first 24 hours. In all cases, proper soft tissue coverage was attained. Post operatively functionally assessed with modified Johner-Wruhs criteria. Results & Discussion: Majority of the patients was less than 40 years and 94% were males. In 84% of cases mode of injury was Road Traffic Accidents.98% involved middle and distal third fractures.68% of cases were AO group A type and had good outcome.86% cases were type 1&2 open and had good outcome. Average time for bony union was 21.4weeks.There was no case of knee stiffness and ankle stiffness was 4%.46% of cases was associated with anterior knee pain.76% had good outcome and only 6% was associated with poor outcome. There was three case of deep infection, 2 cases of nonunion, 1 case of malunion, 8cases of delayed union, 3cases of shortening and cases of distal screw breakage. Conclusion: Primary undreamed interlocking intramedullary nailing as an ideal method for treatment of open tibial fractures type 1, 2 and 3A. Unreamed nails provide a stable fixation preserving the soft tissues sleeve around the fracture site and maintaining the cortical blood flow. Other potential advantages include shorter operative time, less blood loss, early mobilization, shorter hospital and early weight bearing. Complications like infections malunion, nonunion and implant failure is also less. Intial wound management and soft tissue coverage is of paramount importance in the management of open tibial fractures. The nailing procedure is simple and fast and is easily reproducible by an average surgeon with a short learning curve.

Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis.

Nonunion is a highly morbid complication that exacerbates the pain, disability and financial burden of distal and diaphyseal femur fractures. This study examined the modern rates of healing, nonunion, and other complications requiring reoperation of different fixation methods for distal and diaphyseal femur fractures. A systematic review and meta-analysis of all records from PubMed, Embase and the Cochrane Review system was performed. Included studies had >20 acute, non-pathologic distal or diaphyseal femur fractures treated with primary internal fixation. Excluded were studies on abnormal patient/fracture populations, external fixation, or cement/bone graft use. Thirty-eight studies with 2,829 femoral shaft fractures and 11 studies with 505 distal femur fractures were included. Distal fractures had a lower healing rate (86.6% vs. 93.7%) and a higher re-operation rate (13.4% vs 6.1%) than shaft fractures (p < 0.00001), primarily due to higher rates of mechanical failure (p < 0.00001). Nonunion was the most frequent complication, occurring in 4.7% of distal fractures and 2.8% of shaft fractures. There was no difference between plate and nail fixation of distal fractures in healing, nonunion, or other causes of re-operation. Shaft fractures developed nonunion in 6.6% of unreamed nails and 2.1% of reamed nails (p = 0.002). Nonunion occurred in 2.3% of antegrade nailed fractures and 1.5% of retrograde nailed fractures (p = 0.66). Approximately one out of every eight distal fractures and one of every 16 shaft fractures requires re-operation. The most common cause of fixation failure is nonunion. Further research is needed to improve outcomes, particularly in distal femur fractures.

Numerical comparison of two different tibial nails: expert tibial nail and innovative nail

The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. Unreamed nailing favors biology at the expense of the achievable mechanical stability, it is therefore of interest to define the limits of the clinical indications for this method. Extra-articular fractures of the distal tibial metaphysis, meta-diaphyseal junction, and adjacent diaphysis are distinct in their management from impaction derived “pilon” type fractures and mid-diaphyseal fractures. With this purpose a complete model of the human tibia was realized, simulating a mid-diaphyseal fracture, classified as A2 type 1, according to the AO classification. Two different FE models of nail were developed in order to carry on a mechanical comparison between an innovative design of nail for fractures occurring on long bones and a traditional intra-medullary nail expert tibial nail (DePuy Synthes $$^{\textregistered }$$ ). The innovative nail’s functioning is based essentially on sliding of conical surfaces, located in a spindle and in holding pins. Spindle and holding pins are connected together by a sleeve. The sliding transforms the rotational and translational motion of the spindle to a radial expansion of the holding pins, protruding inside the intramedullary canal. Results obtained by a non-linear finite element analysis of the models were performed with Abaqus version 5.4 (Hibbitt, Karlsson and Sorensen, Inc., Pawtucket, RI, USA) using the geometric non-linearity and automatic time stepping options. In particular, analyses confirmed a satisfactory behavior of the nail in terms of stress and strain shielding, comparable to the other traditional system of prosthesis. In conclusion, this kind of nail appears to offer a good solution for elderly patients, which could not endure complications due to a complex surgery, as distal or medial screws are not necessary.

Clinical effect of reamed interlocking intramedullary nail in the treatment of upper tibial fracture

Objective To evaluate the efficacy and safety of reamed interlocking intramedullary nail in the treatment of upper tibial fracture. Methods According to the random number table, 81 patients with tibial fracture were divided into observation group(reaming intramedullary interlocking nails) of 41 cases and control group(unreamed intramedullary nails) of 40 cases.The operation time, healing time, fracture of nail lock, fracture union and infection were observed and compared between the two groups. Results The operation time of the observation group[(55.3±19.2)min] was significantly longer than that of the control group[(44.7±12.4)min]. The healing time of the observation group [(16.2±4.2)weeks]was significantly shorter than that of the control group[(24.1±5.2)weeks], the differences were statistically significant(t=6.543, 8.235, all P 0.05). Conclusion Reamed interlocking intramedullary nail in the treatment of upper tibial fracture has reliable curative effect. The internal fixation is more stable and the healing rate of the patients is faster. Key words: Bone nails; Tibial fractures; Comparative effectiveness research

Radial nerve palsy following closed unreamed nailing of the humeral diaphysis: A case report

Radial nerve palsy following closed unreamed nailing of the humeral diaphysis: A case report

Surgical management of compound fracture tibia using an unreamed interlocking nail

Background and Objectives: With increasing number of vehicles on the roads in India, complex trauma cases caused by traffic accidents have increased progressively. Fracture Tibia are among the commonest fractures sustained in road traffic accidents due to the subcutaneous nature of the tibia, they are frequently open and contaminated fractures. Due to the poor blood supply and poor soft tissue coverage these fractures are frequently complicated by delayed union, malunion, non-union and infection. Controversy exists as to the optimal method of stabilization of compound fractures of Tibia. External Fixation devices had been quite popular in the management of these fractures, but lately unreamed intramedullary nail is being used as the initial management of these fractures as external fixation devices are associated with complications such as communition, displacement, soft tissue injury and pin tract infections moreover wound management and skin closing procedures are easier with Intramedullary nailing, Studies have shown that reaming disrupts the cortical blood flow to a greater extent than the Unreamed nails thereby increasing the susceptibility to infection. When comparing the Unreamed IM nail to the Reamed IM nail, the Unreamed nail with interlocking may provide the same stability as a closely fitting tubular nail but without the danger of jamming. Thus considering all these studies, the Unreamed IM Nail can be used for the management of Compound fractures of Tibia. This study was conducted at the Department of Orthopaedics, Adichunchanagiri institute of medical sciences to evaluate the results of interlocking intramedullary nailing using an unreamed nail in the treatment of the compound fractures of tibia. It was done to compare the advantage of using an interlocking intramedullary nailing without reaming in the treatment of compound fractures of tibia with various studies in terms of time required for union, rate of malunion and malrotation, infection and range of motion of knee and ankle. Materials and Methods: This study was performed on 50 compound fractures of tibia with an unreamed interlocking intramedullary nail at Adichunchanagiri Institute of Medical Sciences & Research centre after attaining ethical clearance. All the cases selected were fresh fractures and mostly traumatic in nature. The procedure was done as early as possible and the secondary procedures of Dynamisation, skin grafting and musculocutaneous flap were done as and when needed. The cases were followed up for an average period of 18 months with 4 visits (6 weeks, 3 months, 6 months and 12 months) Results: Compound fractures of the tibia managed using an unreamed interlocking intra medullary nail gave good functional results and patient satisfaction. It involved minimal surgical trauma and less blood loss. It provides the advantage of early ambulation, lower rates of infection, non-union, mal union and delayed union compared to other treatment modalities. It allows early weight bearing and shorter hospital stay. Interpretation and Conclusions: It was concluded that early interlocking intra medullary nailing using an unreamed nail with immediate soft tissue coverage resulted in good fracture union and low rates of complications compared to other modalities of treatment. It is cost effective with short hospital stay and facilitates earlier return to work. Over all morbidity is reduced and better patient satisfaction noted.

Surgical management of open tibial shaft fractures in adults by reamed versus unreamed intramedullary interlocking nailing: A comparative study

Back ground and objectives: Tibial diaphyseal fractures are one of the commonest long bone fractures encountered by most of the orthopaedic surgeons. Because most of the length of tibia is subcutaneous throughout, open fractures are more common in tibia than in any other major long bone. Because of high prevalence of complications associated with these fractures, management is often is difficult and the optimum method of treatment remains a subject of controversy. This prospective study was conducted at the department of orthopaedics, KIMS Hubli to evaluate and compare the results of closed interlocking intramedullary nailing with and without reaming in the treatment of the open fractures of mid shaft tibia in adults. It was done to compare the efficiency of interlocking intramedullary nailing with and without reaming in treatment of open fractures of mid shaft tibia with other studies in terms of time required for union, rate of malunion and malrotation, rate of infection and range of motion of ankle and knee joint.Materials and methods: This study was done on 50 patients between the age group of 25-40yrs admitted under Department of Orthopaedics of Karnataka Institute of Medical Sciences Hospital, Hubli with open fractures mid shaft of tibia selected based on inclusion & exclusion criteria during the period from 1/08/2013 to 31/07/2015 treated surgically using reamed/unreamed intramedullary interlocking nailing. Of the 50 patients 25 were treated by reamed and 25 by unreamed intramedullary interlocking nailing. All the cases were fresh fractures and traumatic in nature. They were done with the procedure as early as possible and the secondary procedures were done when needed. The cases were followed up for an average period of 6-9 months. None of the cases were lost to follow up. Results: Open fractures of the tibial shaft managed with or without reamed interlocked intramedullary nailing gave good functional results and patient satisfaction It involves minimal surgical trauma and less blood loss. It provides the advantages of early ambulation, lower rates of infection, delayed union, non union and malunion compared to other treatment modalities. It provides with early weight bearing and earlier returns to work. In our series, the overall functional outcome according to Johner and Wruhs’ criteria is equal and there is no significant difference in both reamed and unreamed nailing in open tibial shaft fractures in adults. Interpretation and conclusions: Intramedullary nailing is one of the methods of treatment for open tibial shaft fractures in adults, despite the fact that controversy exists regarding the choice of reamed or unreamed intramedullary nailing. There are no clear indications or contraindications for choosing either option. Clinical and radiographic results of nailing after reaming are similar to those of nailing without reaming for fixation of open fractures of the tibial shaft. The over-all functional outcome according to the Johner and Wruhs’ criteria was similar between the two groups, with no evidence that reaming delays the process of union. Considering the ease of performing the technique and the decreased operative time, unreamed interlocking nailing may have an edge over reamed interlocking nailing.

Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.

Background: Currently, the most widely used technique of osteosynthesis in the treatment of proximal femur fractures is the intramedullary nailing and canal reaming. However, intramedullary canal reaming causes a significant release of IL-6 and an important systemic inflammatory reaction. A surgical variant technique is the introduction of the nail with no canal reaming in order to reduce the trauma produced, to simplify and speed up the process of osteosynthesis and, presumably, to reduce the systemic inflammatory response produced by the reaming procedure.The purpose of the study is the comparative evaluation between the reamed and unreamed surgical techniques in terms of increased biochemical markers of organ damage and inflammation. Material and methods: The retrospective observational study was conducted between March 2014 and October 2015 on a sample of 199 patients. The following values were recorded: D-dimer, Troponin, alkaline phosphatase(ALP), ESR, CRP, LDH at admission, at 1st and 4th postoperative days, and the percentage change was calculated between the values of the fourth postoperative day, and those at admission. The Mann-Whitney test was administered for the significance of differences, with p-value