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2022, Vol. 26 ›› Issue (3): 461-467Application of intramedullary nailing in the treatment of long tubular bone fractures of the extremities: reaming and non-reamingLiu Zemin, Lü Xin
Abstract: BACKGROUND: With the advantages of central fixation, elastic fixation and avoiding stress shielding, intramedullary nail is often used in the treatment of long tubular bone fractures of extremities. The choice of reaming and non-reaming before intramedullary nail implantation has its own advantages and disadvantages, and there is no consensus at present. OBJECTIVE: To summarize the controversial points of reaming and non-reaming, as well as the application status and development direction of intramedullary nail reaming and non-reaming in the treatment of long tubular bone fractures of extremities. METHODS: PubMed, Web of science, CNKI and Wanfang database were searched from January 1900 to March 2021 with the key words of “intramedullary reaming nail, non-reaming nail, femur, tibia, humerus” in Chinese and English, and the full text was searched by manual search. After inclusion and exclusion criteria screening, 57 articles were included in the final review. RESULTS AND CONCLUSION: (1) In the treatment of long tubular bone fractures, reamed and non-reamed intramedullary nail fixations have their own advantages and disadvantages. Reaming operation time is longer, and the risk of pulmonary cerebral embolism is high, but the patients heal quickly and the risk of postoperative locking nail fracture is small, while the time of non-reaming operation is relatively short. (2) The increase of intramedullary pressure and pulmonary cerebral embolism caused by reaming are common in femoral shaft fractures, high speed and slow reaming can reduce the increase of intramedullary pressure and further reduce the risk of pulmonary cerebral embolism. (3) Reaming converts the centrifugal blood flow of the shaft into centripetal blood flow. Simultaneously, the local release of growth factors that promote fracture healing can enhance the osteogenesis of the fracture site. (4) Compared with non-reaming, moderate reaming can be placed into a larger diameter intramedullary nail to increase the contact area of the parietal bone and improve the overall biomechanical stability. (5) Reaming will lead to the destruction of intramedullary blood supply, but extramedullary blood supply will be compensated to make up for the lack of intramedullary blood supply. (6) Fractures of distal humerus were fixed with reamed intramedullary nail in order to avoid iatrogenic fracture. Because of its large medullary diameter and reduced bone strength, the effect of non-reamed intramedullary nail is better for elderly femoral intertrochanteric fracture. For femoral shaft fracture, because of abundant surrounding soft tissue, it can provide good blood supply. For the sake of cost-effectiveness analysis and avoiding the risk of infection, the effect of non-reamed intramedullary nail is better for open tibial fracture. Closed tibial fracture after reaming has the advantages of fast fracture healing, high excellent and good rate, early functional exercise and so on. Reamed intramedullary nail is recommended for the treatment of closed tibial fracture. Key words:reamed intramedullary nail, non-reamed intramedullary nail, humerus fracture, femoral fracture, tibial fractures, fat embolism, fracture healing, biomechanics |