Comparison of Reamed and Nonreamed Solid Core Nailing of the Tibial Diaphysis After External Fixation: A Preliminary Report

From July 1982 to March 1990, 32 patients had an external fixator applied to treat a tibial diaphyseal fracture and subsequently underwent intramedullary nailing16 with reamed and 16 with nonreamed solid core nails. Indications for surgery were 12 atrophic and 1 hypertrophic nonunion in each group....

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Veröffentlicht in:Journal of orthopaedic trauma 1993, Vol.7 (3), p.279-285
Hauptverfasser: Riemer, Barry L, Butterfield, Spencer L
Format: Artikel
Sprache:eng
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Zusammenfassung:From July 1982 to March 1990, 32 patients had an external fixator applied to treat a tibial diaphyseal fracture and subsequently underwent intramedullary nailing16 with reamed and 16 with nonreamed solid core nails. Indications for surgery were 12 atrophic and 1 hypertrophic nonunion in each group. The balance were either planned conversions or inadequate external fixators due to head injuries. All but one were seen by an author at a minimum of 1 year. Among the reamed nails, 3 fractures were grade III B. Two patients had pin tract infections, and there were no prenail wound infections. All infections were clinically inactive at the time of nail insertion. Postnail, 7 patients became infected, requiring 12 debridements and 2 procedures to achieve union. One patient had a plate applied 44 weeks postnail and was lost 48 weeks postnail with a persistent infected nonunion. The average time to union was 26 weeks. In the nonreamed solid core group, 2 fractures were grade III A and 5 grade III B. There were 2 pin and 5 prenail wound infections. One nail was inserted across an active pin tract infection. One tibia became infected postnail (p=.04). The fractures united at an average of 14 weeks postnail (p=.036). Two debridements to control infection but no further procedures to achieve union were necessary (p=.003). When tibial reconstructions following external fixation are required, nonreamed solid core nails are efficacious and may be preferable to reamed nails.
ISSN:0890-5339
1531-2291
DOI:10.1097/00005131-199306000-00014