Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures
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Abstract
Background: Intramedullary nailing (IM nailing) is the standard of care for the treatment of most diaphyseal lower extremity fractures. A few studies have assessed and compared the infection rate following reamed and unreamed IM nailing in open long bone fractures. In the present study, we attempted to compare the infection rate between two procedures in open fractures of tibia. Methods: In this prospective study, we included consecutive patients suffering from open fractures of tibia (Gustilo subtypes II or IIIA) who required IM nailing. Patients younger than 16 years old, other Gustilo types (I, IIIB, and IIIC), fractures reaching to the tibial plateau articular surface, and simultaneous fractures of other bones in the extremity were excluded. All patients were followed up for one year to assess the postoperative infection rate.
Results: Of 59 patients, 37 underwent reamed IM nailing and 22 underwent unreamed IM nailing. In reamed group, 4 cases (10.8%) experienced an infection requiring reoperation and antibiotic therapy, while in the unreamed group, it was 5 cases (22.7%). The difference between the groups was not statistically significant.
Conclusion: Reamed and unreamed IM nailing procedures for fractures of tibia have similar outcome regarding long-term postoperative infections that require reoperation and antibiotic therapy.
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2. Court-Brown CM, McQueen MM, Quaba AA, Christie J. Locked intramedullary nailing of open tibial fractures. J Bone Joint Surg Br. 1991;73(6):959-64. [PubMed: 1955445].
3. Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC, Varecka TF. A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma. 2000;14(3):187-93. doi: 10.1097/00005131-200003000-00007. [PubMed: 10791670].
4. Yoon RS, Liporace FA. Intramedullary nail and plate combination fixation for complex distal tibia fractures: When and how? J Orthop Trauma. 2016;30(Suppl 4):S17-S21. doi: 10.1097/BOT.0000000000000698. [PubMed: 27768628].
5. Scolaro JA, Broghammer FH, Donegan DJ. Intramedullary tibial nail fixation of simple intraarticular distal tibia fractures. J Orthop Trauma. 2016;30(Suppl 4):S12-S16. doi: 10.1097/BOT.0000000000000697. [PubMed: 27768627].
6. Vecsei V, Seitz H, Greitbauer M, Heinz T. Borderline indications for locked intramedullary nailing of femur and tibia. Orthopade. 1996;25(3):234-46. [PubMed: 8766662].
7. Talerico M, Ahn J. Intramedullary nail fixation of distal tibia fractures: Tips and tricks. J Orthop Trauma. 2016;30(Suppl4):S7-S11. doi: 10.1097/BOT.0000000000000693. [PubMed:
27768626].
8. Galal S. Minimally invasive plate osteosynthesis has equal safety to reamed intramedullary nails in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures. Injury. 2018;49(4):866-70. doi: 10.1016/j.injury.2018.03.008. [PubMed: 29530513].
9. Hofmann A, Dietz SO, Pairon P, Rommens PM. The role of intramedullary nailing in treatment of open fractures. Eur J Trauma Emerg Surg. 2015;41(1):39-47. doi: 10.1007/s00068-014-0485-5. [PubMed: 26038164].
10. Xia L, Zhou J, Zhang Y, Mei G, Jin D. A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures. Orthopedics. 2014;37(4):e332-e338. doi: 10.3928/01477447-20140401-52. [PubMed: 24762836].
11. Aparicio G, Soler I, Lopez-Duran L. Fat embolism syndrome after nailing an isolated open tibial fracture in a stable patient: A case report. BMC Res Notes. 2014;7:237. doi:
10.1186/1756-0500-7-237. [PubMed: 24731759]. [PubMed Central: PMC3996492].
12. Giannoudis PV, Tzioupis C, Pape HC. Fat embolism: The reaming controversy. Injury. 2006;37(Suppl 4):S50-S58. doi: 10.1016/j.injury.2006.08.040. [PubMed: 16990061].
13. Torrero JI, Aroles F. Effect of intramedullary nails in tibial shaft fractures as a factor in raised intracompartmental pressures: A clinical study. Eur J Trauma Emerg Surg. 2009;35(6):553-61. doi: 10.1007/s00068-009-9097-x. [PubMed: 26815379].
14. Giannoudis PV, Snowden S, Matthews SJ, Smye SW, Smith RM. Temperature rise during reamed tibial nailing. Clin Orthop Relat Res. 2002;(395):255-61. doi: 10.1097/00003086-200202000-00031. [PubMed: 11937890].
15. Li CX, Zhao HJ, Zhao WQ, Xu YQ. System evaluation on reamed and non-reamed intramedullary nailing in the treatment of closed tibial fracture. Acta Cir Bras. 2013;28(10):744-50. doi:
10.1590/s0102-86502013001000010. [PubMed: 24114305].
16. Shao Y, Zou H, Chen S, Shan J. Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures. J Orthop Surg Res. 2014;9:74. doi: 10.1186/s13018-014-0074-7. [PubMed: 25149501]. [PubMed Central: PMC4145248].
17. Keating JF, O'Brien PJ, Blachut PA, Meek RN, Broekhuyse HM. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am. 1997;79(3):334-41. doi: 10.2106/00004623-199703000-00003. [PubMed: 9070520].
18. Sarmiento A, Latta LL. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2009;91(5):1274-5. [PubMed: 19411479].
19. Young S, Lie SA, Hallan G, Zirkle LG, Engesaeter LB, Havelin LI. Risk factors for infection after 46,113 intramedullary nail operations in low- and middle-income countries. World J Surg. 2013;37(2):349-55. doi: 10.1007/s00268-012-1817-4. [PubMed: 23052810]. [PubMed Central: PMC3553402].
20. Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: A prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998;12(1):1-7. doi: 10.1097/00005131-199801000-00001. [PubMed: 9447512].
21. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984-8. doi: 10.1302/0301-620X.92B7.22959. [PubMed: 20595119].
22. Littenberg B, Weinstein LP, McCarren M, Mead T, Swiontkowski MF, Rudicel SA, et al. Closed fractures of the tibial shaft. A meta-analysis of three methods of treatment. J Bone Joint Surg Am. 1998;80(2):174-83. doi: 10.2106/00004623-199802000-00004. [PubMed: 9486723].
2. Court-Brown CM, McQueen MM, Quaba AA, Christie J. Locked intramedullary nailing of open tibial fractures. J Bone Joint Surg Br. 1991;73(6):959-64. [PubMed: 1955445].
3. Finkemeier CG, Schmidt AH, Kyle RF, Templeman DC, Varecka TF. A prospective, randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft. J Orthop Trauma. 2000;14(3):187-93. doi: 10.1097/00005131-200003000-00007. [PubMed: 10791670].
4. Yoon RS, Liporace FA. Intramedullary nail and plate combination fixation for complex distal tibia fractures: When and how? J Orthop Trauma. 2016;30(Suppl 4):S17-S21. doi: 10.1097/BOT.0000000000000698. [PubMed: 27768628].
5. Scolaro JA, Broghammer FH, Donegan DJ. Intramedullary tibial nail fixation of simple intraarticular distal tibia fractures. J Orthop Trauma. 2016;30(Suppl 4):S12-S16. doi: 10.1097/BOT.0000000000000697. [PubMed: 27768627].
6. Vecsei V, Seitz H, Greitbauer M, Heinz T. Borderline indications for locked intramedullary nailing of femur and tibia. Orthopade. 1996;25(3):234-46. [PubMed: 8766662].
7. Talerico M, Ahn J. Intramedullary nail fixation of distal tibia fractures: Tips and tricks. J Orthop Trauma. 2016;30(Suppl4):S7-S11. doi: 10.1097/BOT.0000000000000693. [PubMed:
27768626].
8. Galal S. Minimally invasive plate osteosynthesis has equal safety to reamed intramedullary nails in treating Gustilo-Anderson type I, II and III-A open tibial shaft fractures. Injury. 2018;49(4):866-70. doi: 10.1016/j.injury.2018.03.008. [PubMed: 29530513].
9. Hofmann A, Dietz SO, Pairon P, Rommens PM. The role of intramedullary nailing in treatment of open fractures. Eur J Trauma Emerg Surg. 2015;41(1):39-47. doi: 10.1007/s00068-014-0485-5. [PubMed: 26038164].
10. Xia L, Zhou J, Zhang Y, Mei G, Jin D. A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures. Orthopedics. 2014;37(4):e332-e338. doi: 10.3928/01477447-20140401-52. [PubMed: 24762836].
11. Aparicio G, Soler I, Lopez-Duran L. Fat embolism syndrome after nailing an isolated open tibial fracture in a stable patient: A case report. BMC Res Notes. 2014;7:237. doi:
10.1186/1756-0500-7-237. [PubMed: 24731759]. [PubMed Central: PMC3996492].
12. Giannoudis PV, Tzioupis C, Pape HC. Fat embolism: The reaming controversy. Injury. 2006;37(Suppl 4):S50-S58. doi: 10.1016/j.injury.2006.08.040. [PubMed: 16990061].
13. Torrero JI, Aroles F. Effect of intramedullary nails in tibial shaft fractures as a factor in raised intracompartmental pressures: A clinical study. Eur J Trauma Emerg Surg. 2009;35(6):553-61. doi: 10.1007/s00068-009-9097-x. [PubMed: 26815379].
14. Giannoudis PV, Snowden S, Matthews SJ, Smye SW, Smith RM. Temperature rise during reamed tibial nailing. Clin Orthop Relat Res. 2002;(395):255-61. doi: 10.1097/00003086-200202000-00031. [PubMed: 11937890].
15. Li CX, Zhao HJ, Zhao WQ, Xu YQ. System evaluation on reamed and non-reamed intramedullary nailing in the treatment of closed tibial fracture. Acta Cir Bras. 2013;28(10):744-50. doi:
10.1590/s0102-86502013001000010. [PubMed: 24114305].
16. Shao Y, Zou H, Chen S, Shan J. Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures. J Orthop Surg Res. 2014;9:74. doi: 10.1186/s13018-014-0074-7. [PubMed: 25149501]. [PubMed Central: PMC4145248].
17. Keating JF, O'Brien PJ, Blachut PA, Meek RN, Broekhuyse HM. Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft. A prospective, randomized study. J Bone Joint Surg Am. 1997;79(3):334-41. doi: 10.2106/00004623-199703000-00003. [PubMed: 9070520].
18. Sarmiento A, Latta LL. Randomized trial of reamed and unreamed intramedullary nailing of tibial shaft fractures. J Bone Joint Surg Am. 2009;91(5):1274-5. [PubMed: 19411479].
19. Young S, Lie SA, Hallan G, Zirkle LG, Engesaeter LB, Havelin LI. Risk factors for infection after 46,113 intramedullary nail operations in low- and middle-income countries. World J Surg. 2013;37(2):349-55. doi: 10.1007/s00268-012-1817-4. [PubMed: 23052810]. [PubMed Central: PMC3553402].
20. Henley MB, Chapman JR, Agel J, Harvey EJ, Whorton AM, Swiontkowski MF. Treatment of type II, IIIA, and IIIB open fractures of the tibial shaft: A prospective comparison of unreamed interlocking intramedullary nails and half-pin external fixators. J Orthop Trauma. 1998;12(1):1-7. doi: 10.1097/00005131-199801000-00001. [PubMed: 9447512].
21. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br. 2010;92(7):984-8. doi: 10.1302/0301-620X.92B7.22959. [PubMed: 20595119].
22. Littenberg B, Weinstein LP, McCarren M, Mead T, Swiontkowski MF, Rudicel SA, et al. Closed fractures of the tibial shaft. A meta-analysis of three methods of treatment. J Bone Joint Surg Am. 1998;80(2):174-83. doi: 10.2106/00004623-199802000-00004. [PubMed: 9486723].
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| Issue | Vol 5, No 2 (2019) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v5i2.3749 | |
| Keywords | ||
| Infection reamed and un-reamed intramedullary nailing open tibia fractures | ||
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How to Cite
1.
Amoozadeh Omrani F, Elahi M, Sarzaeem MM, Sayadi S, Farzaneh H. Infection Rate of Reamed versus Unreamed Intramedullary Nailing in Open Tibia Fractures. J Orthop Spine Trauma. 2020;5(2):29-31.
