Reaming during anterograde femoral nailing: is it worth it?

• Published in: Injury Vol. 36; no. 3; pp. 445 - 449
• Main Authors: Forster, M.C., Aster, A.S., Ahmed, S.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.03.2005; Elsevier
• Subjects: Adult; Biological and medical sciences; Blood Loss, Surgical - physiopathology; Bone Nails; Femoral Fracture; Femoral Fractures - physiopathology; Femoral Fractures - surgery; Femur - surgery; Fracture fixation; Fracture Fixation, Intramedullary - methods; Fractures, Ununited - surgery; Humans; Injuries of the limb. Injuries of the spine; Intramedullary; Medical sciences; Meta-analysis; Reoperation; Time Factors; Traumas. Diseases due to physical agents; Treatment Outcome; Femoral Fracture; Fracture fixation; Intramedullary; Meta-analysis; Human; Reaming; Pseudoarthrosis; Delayed union; Reoperation; Prognosis; Methodology; Diseases of the osteoarticular system; Nailing; Fracture; Review; Trauma; Heterogeneity; Nail; Nail(anatomy); Advantage; Follow up study; Anterograde; Blood loss; Adult; Models; Comparative study; Bibliographic review
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2004.07.031

A systematic review was performed to assess the relative merits of reamed and unreamed antegrade femoral nailing. To be included, a study had to be prospective, randomised or pseudorandomised, comparing reamed and unreamed antegrade femoral nailing in adults. Where more than one study from the same institution was available, only the study with longest follow-up was included. A literature search found 2044 possible articles. Of these, eight studies compared reamed and unreamed femoral nailing. The methodology of these articles was independently assessed by all the three authors. Five studies met the inclusion criteria. Each outcome measure tested was assessed for heterogeneity. If significant heterogeneity was present, the data were not combined. If there was no significant heterogeneity, a combined odds ratio or weighted mean difference was calculated using a fixed effects model, and a Z-test was performed to test the overall effect. Six hundred and forty-seven femoral fractures (315 reamed; 332 unreamed) were entered into the included studies. Unreamed nailing was quicker and associated with significantly less blood loss ( P < 0.00001). Reaming significantly reduced the time to union ( P = 0.00001), non-union ( P = 0.002), delayed union ( P = 0.005), technical problems ( P = 0.01) and reoperation rate ( P = 0.001). The use of reamed femoral nails gives significant advantages over unreamed femoral nails.