Reamed vs Unreamed IM Nails - Roland Russell 17/2/2004

h1 style="MARGIN: 0cm 0cm 0pt"> Medline search of ‘ reamed versus unreamed nails’ revealed 12 papers.


1)Effect of acute reamed versus undreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures: a randomised prospective study

Nassif JM, Gorczyca JT, Cole JK, Pugh KJ, Pienkowski D

Division of Orthopaedics , University of Kentucky , Lexington , USA

48 Adults with 49 #s nailed within 3 days of #s

compartment pressure monitored postoperatively in anterior and deep posterior compartment pressures

peak pressure obtained during reaming in reamed group and nail placement in the unreamed group

no patients got compartment syndrome and peak pressures were in fact higher in the unreamed   group


4 prospective randomised studies

1) Prospective randomised study of reamed versus unreamed femoral   intramedullary nailing; an assessment of procedures

Shephard LE, Shean CJ, Gelais ID, Lee J, Carter VS

Los Angeles County / University of Southern California Medical Centre

      J Orthopaedic Trauma 2001 Aug

      Supports use of undreamed( easier , less blood loss) but does not look at union


2) Prospective randomised study of reamed versus unreamed femoral intramedullary nailing : an assessment of procedures

Gopal S, Giannoudis PV



3) Reamed or unreamed Nailing For Closed Tibial Fractures

A Prospective Study in Tscherne C1 Fractures

C.M Court-Brown, J Christie, M Mcqueen Royal Infirmary of Edinburgh , Scotland

JBJS(BR) VOL 78 No 4 JULY 1996

Jan 1993-Jan 1994, Prospective, randomised trial.



50 patients with Tscherne C1 tibial diaphyseal fractures

reamed Grosse-Kempf tibial nail VS undreamed AO UTN nail

Randomised using prefilled envelopes

Reamed nails-at least 11mm-inserted using standardised technique of Court-Brown

Unreamed at least 8 or 9 mm in diameter-inserted according manufacturers instruction

1.5g cefuroxime at induction + 8 and 16 hours postop

Compartment pressure monitoring all patients


                              Reamed Group              Unreamed Group


Mean Age                   35 years                        36.1 years

% Males                    78%                               68%

AO Type A#               23                                   30


Similar postoperative regime. All followed up for one year in a research clinic.

Research physiotherapist assessed time to union, malunion, infection, further surgery and anterior knee pain.

Mobility of   knee, ankle, and subtalar joints assessed 3,6 and 12 months

Time to return to work noted

Union=x-ray+Court-Brown clinical criteria

Malunion=>5 degrees of angular or rotary malalignment

                   Or > 1cm leg length discrepancy

Exchange nailing performed if atrophic union at 12 to 14 weeks or persistant hypertrophic non-union

Stats: Mann Whitney- difference in union

          Fisher’s difference in requirement for second operation


RESULTS                               REAMED                      UNREAMED

MEAN UNION                        15.4 WEEKS                    22.8 WEEKS              P<0.01

                                               (11 TO 25)                         (12 TO 36)             significant

Exchange Nailing                           0                                    5 patients                  p=0.05

Malunion                                        0                                    4 patients

Mechanical Failure             1   Screw breakage           13 Screw Breakage

                                            0 nail Breakage                1 Broken Nail

Compartment Synd                      2                                      3

Return to Work                         10.9                                   9.3 ( NOT SIG)

Incidence of knee pain               60%                                   54%


No significant difference between mobility of knee ankle and subtalar joints



Unreamed nail compared to reamed for Tscherne C1 tibial diaphyseal #:-

1 prolonged time to union

2 notable incidence of non-union

3 increased exchange nailing-although p value not quite significant

This paper supports the use of reamed nailing.



1)       50 Patients- perhaps more required

2)         ? grosse-kempf nail and undreamed AO nail comparable

3)       prospective, randomised

4)       ? same surgeon, if not ? comparable grade

5)       significant increase time in union for undreamed group


Reamed Versus Nonreamed Anterograde Femoral Nailing

Tornetta, Paul III; Tiburzi, Douglas

Boston Medical Centre, Boston Massachussetts , USA


Vol 14(1) January 2000 pg 15-19

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