Friction burns within the tibia during reaming

Abstract

We have carried out a prospective, randomised trial to measure the rise of temperature during reaming of the tibia before intramedullary nailing. We studied 34 patients with a mean age of 35.1 years (18 to 63) and mean injury severity score of 10 (9 to 13). The patients were randomised into two groups: group 1 included 18 patients whose procedure was undertaken without a tourniquet and group 2, 16 patients in whom a tourniquet was used. The temperature in the bone was measured directly by two thermocouples inserted into the cortical bone near the isthmus of the tibial diaphysis. Reaming was carried out to at least 1.5 mm above the required diameter of the nail. Blood loss was assessed by recording the preoperative and postoperative haemoglobin (Hb) level.The minimum clinical follow-up was six months. In group 1 (no tourniquet), the mean Hb dropped 2.8 g/dl from 14.3 ± 1.02 g/dl to 11.5 ± 1.04 g/dl (p = 0.0001), whereas with the tourniquet, the mean decrease was 1.3 g/dl from 14 ± 1 g/dl to 12.7 ± 1.3 g/dl (p = 0.007). This difference was not statistically significant. The mean initial tibial temperature was 35.6°C (SD 0.6) and rose with reaming to levels between 36.3°C and 51.6°C. The highest temperatures were obtained with the largest reamers (11 and 12 mm, p = 0.0001) and the most rapid rise with the smallest diameters of medullary canal (8 or 9 mm). The rise of temperature was transient (20s).We were unable to identify any effect of the use of a tourniquet on the temperature achieved. Reamed intramedullary tibial nailing induces a transient elevation of temperature which is directly related to the amount of reaming.

Successful fifth metatarsal bulk autograft reconstruction of thermal necrosis post intramedullary fixation

“…Awareness of the excellent bone quality and potential poorer condition of the instruments should prompt consideration of cooling with irrigation during reaming. Smaller canal sizes have been implicated in increased temperature rises in tibial reaming [1], while tourniquet usage is insignificant in mitigating thermal necrosis [13]. Recommendations in femoral reaming include sharp reamers, slow advancement, and high revolutions [2], which would likely reduce the risk of thermal necrosis in the MT5.…”

Thermal Injury Complicating Improperly Reamed Intramedullary Nailing of the Tibia -A Case Report-

“…Internal transport was finished and consolidation of regenerates was visible, and bone graft and bone marrow injection was performed at the docking site. 3,6) . 그리 고 골 내강이 고열에 노출되어 골 조직의 국소 괴사가 발 생하면 조직학적으로 골막하, 내부 피질골 및 골수의 정상 구조의 변화가 생기며 2) , 열손상을 받은 주위 피부에 물집 이 발생하고 이후 심부 감염과 골 및 피부의 괴사가 진행 된다고 보고하였다 …”

Bone Transport Treatment of Osteomyelitis Due to Thermal Osteonecrosis After IM Nailing of Tibial Stress Fracture Nonunion

“…Although rare, one of the complications of IMN of tibial shaft fractures is infection, which is reported to occur in 1% to 2% of cases for closed fractures 2 . Thermal osteonecrosis is a risk factor of infection after tibial IMN that occurs during reaming of the medullary canal, which has been reported in several case reports 3 . Risk factors of thermal osteonecrosis during IMN include reaming a narrow medullary canal, use of a tourniquet, and use of a longer, duller reamer with shallow flutes 4 .…”