Reamed versus Nonreamed Intramedullary Nailing for Femoral Fractures: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LIAO Yi ¹ , WANG Xinling ² , WU Taixiang ³

1. Department of Orthopaedics; Kelamayi City Central Hospital; Kelamayi 834000; China2. Department of Nuclear Medicine; Kelamayi City Central Hospital; Kelamayi 834000; China3. Chinese Evidence-Based Medicine Centre/Clinical Epidemiology Resource and Training Centre （Chengdu）; West China Hospital; Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Femoral fractures; Reamed nailing; Nonreamed nailing; Fracture Fixation, Intramedullary; Systematic review

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the effectiveness of reamed versus nonreamed intramedullary nailing for femoral fractures.
Methods 　Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) were identified from MEDLINE (1966-2004.5), EMBASE (1966-2004.5), Cochrane Library (Issue 2, 2004), Cochrane Musculoskeletal Injuries Group Database (2004.5), and CBM disc (1979-2004.5). We handsearched Chinese Journal of Orthopaedy (from establishment to May 2004) and Orthopaedic Journal of China (from establishment to May 2004) . RCTs and CCTs were included. Data were extracted by two reviewers with designed extraction form. RevMan 4.2.3 software was used for data analysis.
Results 　Five RCTs and two CCTs were included. The combined results of meta-analysis showed that reamed intramedullary nailing for femoral fractures can reduce the rate of nonunion (RR=0.38, 95%CI 0.17 to 0.83, P=0.01) and the rate of implant failure (RR=0.42, 95%CI 0.20 to 0.89, P=0.02).
Conclusions 　Compared with nonreamed intramedullary nailing for femoral fractures, reamed intramedullary nailing can reduce the rates of nonunion and implant failure. However, the relation between reaming or pulmonary complications, the time of union, infection, malunion, operative time, and blood loss needs further study.

Citation： LIAO Yi,WANG Xinling,WU Taixiang. Reamed versus Nonreamed Intramedullary Nailing for Femoral Fractures: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2004, 04(9): 620-626. doi: Copy

1.	［1］Brumback RJ, Virkus WW. Intramedullary nailing of the femur: reamed versus nonreamed[J]. J Am Acad Orthop Surg, 2000; 8(2): 83-90.
2.	［2］Debrauwer S, Hendrix K, Verdonk R. Anterograde femoral nailing with a reamed interlocking titanium alloy nail[J]. Acta Orthop Belg, 2000; 66(5): 484-489.
3.	［3］Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures[J]. J Orthop trauma, 2001; 15(1): 28-32.
4.	［4］Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’Handbook 4.2.1[updated December 2003][M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, Issue 1.
5.	［5］Anonymous. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial[J]. J Bone Joint Surg Am, 2003; 85(11): 2 093-2 096.
6.	［6］Tornetta P 3rd, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing[J]. J Orthop Trauma, 2000; 14(1): 15-19.
7.	［7］Clatworthy MG, Clark DI, Gray DH, Hardy AE. Reamed versus unreamed femoral nails. A randomised, prospective trial[J]. J Bone Joint Surg Br, 1998; 80(3): 485-489.
8.	［8］Powell J, DeGroote R, Buckley R, Feibel R, Leighton R, McCormack R, McKee M, Schemitsch EH. A prospective randomised clinical trial comparing reamed vs unreamed intramedullary nailing of femoral shaft fractures: an assessment of pulmonary dysfunction[J]. J Bone Joint Surg Br, 2000; 82 (Suppl 2): 148-149.
9.	［9］Bone LB, Kowalski J, Rohrbacher B, Stegemann P. Reamed versus unreamed femoral nailing: a prospective randomized study[C]. Presented at the 12th Annual Meeting of the Orthopaedic Trauma Association, Boston, Massachusetts, 1996.
10.	［10］Selvakumar K, Saw KY, Fathima M. Comparison study between reamed and unreamed nailing of closed femoral fractures[J]. Med J Malaysia, 2001; 56 Suppl D: 24-28.
11.	［11］Tuzuner T, Subasi M, Kapukaya A, Necmioglu NS. Treatment of femoral shaft fractures with interlocking intramedullary nailing[J]. Acta Orthop Traumatol Turc, 2002; 36(3): 211-219.
12.	［12］Arazi M, Ogun TC, Oktar MN, Memik R, Kutlu A. Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure[J]? J Trauma, 2001; 50(4): 711-716.
13.	［13］Reichert ILH, McCarthy ID, Hughes SPF. The acute vascular response to intramedullary nailing: microsphere estimation of blood flow in the intact ovine tibia[J]. J Bone Joint Surg Br, 1995; 77-B(3): 490-493.
14.	［14］Bhandari M, Guyatt GH, Tong D, Adili A, Shaughnessy SG. Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis[J]. J Orthop Trauma, 2000; 14(1): 2-9.
15.	［15］Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail[J]. J Bone Joint Surg Am, 1999; 81(11): 1 538-1 544.
16.	［16］Hulth A. Current concepts of fracture healing[J]. Clin Orthop, 1989; (249): 265-284.
17.	［17］Zhang YM, Liang GH, Feng GP, Chen ZY. The effect of reaming on intramedullary pressure and pulmonary fat embolization[J]. Chin J Orthop, 1999; 19(8): 494-497.
18.	张毅敏, 梁国穗, 冯国培, 陈振宇. 扩髓对髓内压和肺部脂肪栓塞的影响[J]. 中华骨科杂志, 1999; 19(8): 494～497.
19.	［18］Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing demonstrated by intraoperative echocardiography[J]. Injury, 1993; 24 (Suppl 3): 73-81.
20.	［19］Pape H, Regel G, Dwenger A, Sturm J, Tscherne H. Influence of thoracic trauma and primary femoral intramedullary nailing on the incidence of ARDS in multiple trauma patients[J]. Injury, 1993; 24 (Suppl 3): 82-103.
21.	［20］Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, Sturm JA, Tscherne H. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma[J]. J Trauma, 1993; 35(5): 709-716.
22.	［21］Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R. Transcardiac echocardiography during invasive intramedullary procedures[J]. J Bone Joint Surg Br, 1995; 77(3): 450-455.
23.	［22］Charash WE, Fabian TC, Croce M. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma[J]. J Trauma, 1994; 37(4): 667-672.
24.	［23］Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilisation of fractures: a prospective randomized study[J]. J Bone Joint Surg Am, 1989; 71(3): 336-340.
25.	［24］Helttula I, Karanko M, Gullichsen E. Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures[J]. J Trauma, 2000; 48(4): 704-710.
26.	［25］Liu SJ, Li FB, Chen LY, Pan T, Peng XS. The influence of reamed and unreamed femoral intramedullary nailing on function of pulmonary gas exchange[J]. Orthop J Chin, 2003; 11(1): 27-29.
27.	刘世敬, 李佛保, 陈立言, 潘滔, 彭新生. 股骨干骨折扩髓与不扩髓固定对肺气体交换功能的影响[J]. 中国矫形外科杂志, 2003; 11(1): 27～29.

1. ［1］Brumback RJ, Virkus WW. Intramedullary nailing of the femur: reamed versus nonreamed[J]. J Am Acad Orthop Surg, 2000; 8(2): 83-90.
2. ［2］Debrauwer S, Hendrix K, Verdonk R. Anterograde femoral nailing with a reamed interlocking titanium alloy nail[J]. Acta Orthop Belg, 2000; 66(5): 484-489.
3. ［3］Shepherd LE, Shean CJ, Gelalis ID, Lee J, Carter VS. Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: an assessment of procedures[J]. J Orthop trauma, 2001; 15(1): 28-32.
4. ［4］Alderson P, Green S, Higgins JPT, editors. Cochrane Reviewers’Handbook 4.2.1[updated December 2003][M/CD]. Section 6. In: The Cochrane Library. The Cochrane Collaboration. Oxford: 2004, Issue 1.
5. ［5］Anonymous. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial[J]. J Bone Joint Surg Am, 2003; 85(11): 2 093-2 096.
6. ［6］Tornetta P 3rd, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing[J]. J Orthop Trauma, 2000; 14(1): 15-19.
7. ［7］Clatworthy MG, Clark DI, Gray DH, Hardy AE. Reamed versus unreamed femoral nails. A randomised, prospective trial[J]. J Bone Joint Surg Br, 1998; 80(3): 485-489.
8. ［8］Powell J, DeGroote R, Buckley R, Feibel R, Leighton R, McCormack R, McKee M, Schemitsch EH. A prospective randomised clinical trial comparing reamed vs unreamed intramedullary nailing of femoral shaft fractures: an assessment of pulmonary dysfunction[J]. J Bone Joint Surg Br, 2000; 82 (Suppl 2): 148-149.
9. ［9］Bone LB, Kowalski J, Rohrbacher B, Stegemann P. Reamed versus unreamed femoral nailing: a prospective randomized study[C]. Presented at the 12th Annual Meeting of the Orthopaedic Trauma Association, Boston, Massachusetts, 1996.
10. ［10］Selvakumar K, Saw KY, Fathima M. Comparison study between reamed and unreamed nailing of closed femoral fractures[J]. Med J Malaysia, 2001; 56 Suppl D: 24-28.
11. ［11］Tuzuner T, Subasi M, Kapukaya A, Necmioglu NS. Treatment of femoral shaft fractures with interlocking intramedullary nailing[J]. Acta Orthop Traumatol Turc, 2002; 36(3): 211-219.
12. ［12］Arazi M, Ogun TC, Oktar MN, Memik R, Kutlu A. Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures: is it a safe procedure[J]? J Trauma, 2001; 50(4): 711-716.
13. ［13］Reichert ILH, McCarthy ID, Hughes SPF. The acute vascular response to intramedullary nailing: microsphere estimation of blood flow in the intact ovine tibia[J]. J Bone Joint Surg Br, 1995; 77-B(3): 490-493.
14. ［14］Bhandari M, Guyatt GH, Tong D, Adili A, Shaughnessy SG. Reamed versus nonreamed intramedullary nailing of lower extremity long bone fractures: a systematic overview and meta-analysis[J]. J Orthop Trauma, 2000; 14(1): 2-9.
15. ［15］Brumback RJ, Toal TR Jr, Murphy-Zane MS, Novak VP, Belkoff SM. Immediate weight-bearing after treatment of a comminuted fracture of the femoral shaft with a statically locked intramedullary nail[J]. J Bone Joint Surg Am, 1999; 81(11): 1 538-1 544.
16. ［16］Hulth A. Current concepts of fracture healing[J]. Clin Orthop, 1989; (249): 265-284.
17. ［17］Zhang YM, Liang GH, Feng GP, Chen ZY. The effect of reaming on intramedullary pressure and pulmonary fat embolization[J]. Chin J Orthop, 1999; 19(8): 494-497.
18. 张毅敏, 梁国穗, 冯国培, 陈振宇. 扩髓对髓内压和肺部脂肪栓塞的影响[J]. 中华骨科杂志, 1999; 19(8): 494～497.
19. ［18］Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing demonstrated by intraoperative echocardiography[J]. Injury, 1993; 24 (Suppl 3): 73-81.
20. ［19］Pape H, Regel G, Dwenger A, Sturm J, Tscherne H. Influence of thoracic trauma and primary femoral intramedullary nailing on the incidence of ARDS in multiple trauma patients[J]. Injury, 1993; 24 (Suppl 3): 82-103.
21. ［20］Pape HC, Regel G, Dwenger A, Krumm K, Schweitzer G, Krettek C, Sturm JA, Tscherne H. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma[J]. J Trauma, 1993; 35(5): 709-716.
22. ［21］Christie J, Robinson CM, Pell AC, McBirnie J, Burnett R. Transcardiac echocardiography during invasive intramedullary procedures[J]. J Bone Joint Surg Br, 1995; 77(3): 450-455.
23. ［22］Charash WE, Fabian TC, Croce M. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma[J]. J Trauma, 1994; 37(4): 667-672.
24. ［23］Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilisation of fractures: a prospective randomized study[J]. J Bone Joint Surg Am, 1989; 71(3): 336-340.
25. ［24］Helttula I, Karanko M, Gullichsen E. Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures[J]. J Trauma, 2000; 48(4): 704-710.
26. ［25］Liu SJ, Li FB, Chen LY, Pan T, Peng XS. The influence of reamed and unreamed femoral intramedullary nailing on function of pulmonary gas exchange[J]. Orthop J Chin, 2003; 11(1): 27-29.
27. 刘世敬, 李佛保, 陈立言, 潘滔, 彭新生. 股骨干骨折扩髓与不扩髓固定对肺气体交换功能的影响[J]. 中国矫形外科杂志, 2003; 11(1): 27～29.

Chinese Journal of Evidence-Based Medicine

Reamed versus Nonreamed Intramedullary Nailing for Femoral Fractures: A Systematic Review

Abstract Full text Figures/Tables Video References Cited by

Format

Content