Session I - Femur Fractures

Reamed Versus Unreamed Femoral Nailing: A Prospective Randomized Study

Lawrence Bone, MD, Joseph Kowalski, MD, Bernhard Rohrbacher, MD, Philip Stegemann, MD

SUNY at Buffalo, Buffalo, NY

Hypothesis: Unreamed femoral nailing of femoral shaft fractures would perform as well as reamed femoral nailing.

Methods and Materials: Seventy-two consecutive patients with femoral shaft fractures over an 18 month period were prospectively randomized to unreamed or reamed femoral nailing. Preoperative and postoperative oxygenation parameters and respiratory support needs were recorded. The patients were followed at regular intervals and AP and lateral radiographs were used to determine healing (bridging callus on two views). Clinical evaluation was performed and a Short Form (SF-36) General Health Survey was obtained.

Results: Thirty-three reamed nails and 42 unreamed nails were inserted. Follow-up to union was obtained on 29 reamed (three lost to follow-up) and 35 unreamed, (three unrelated deaths, two lost to follow-up). Union occurred at an average of 21 weeks with the reamed nail and 25 weeks with the unreamed nail. There was no difference in respiratory parameters between the two groups. The SF-36 Health Survey averaged the same for both groups. Two patients with reamed nails had dynamization of their statically locked nail to help healing. Five patients with unreamed nails had dynamization to help healing and two patients required exchange to reamed nailing and bone grafting for delayed union. There was no difference in alignment or functional outcome in the two groups. There was no implant failure.

Discussion: This prospective, randomized study disproved the hypothesis. The increased time to union and the increased number of patients needing exchange nailing showed that the unreamed nail did not perform as well as the reamed nail.

Conclusion: For routine closed femoral shaft fractures, a reamed femoral nail is the implant of choice.