Infection After Reamed Intramedullary Nailing of the Tibia

Abstract

A number of deep infections after reamed intramedullary tibial nailing are avoidable. Particular attention must be paid to correct reaming, exchange nailing, and fasciotomy closure in closed fractures. In open fractures, marginal flap necrosis should be actively treated and not left to granulate.

Management of Infection After Intramedullary Nailing of Long Bone Fractures: Treatment Protocols and Outcomes

“…There were 25 cases of stage I infection (1.16%) [3, 4, 5, 9, 11, 12, 19, 26], 120 cases of stage II infection (5.6%) [7, 9-17, 19, 20, 21, 22, 24-30] and 26 cases of stage III infection (1.2%) [6, 7, 8, 12, 22, 27, 30]. All stage I infection cases were successfully treated with nail retaining, incision and drainage where it was felt to be necessary and antibiotic administration.…”

Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials

“…However, the choice between two alternative intramedullary nailing approaches, reamed or unreamed, is an ongoing controversy. Reamed intramedullary nailing has the advantage of providing optimal biomechanical stability; however, reaming of the medullary canal may also lead to endosteal blood flow damage, bone necrosis, compartment syndrome and infection [9][10][11]. In theory, unreamed intramedullary nailing does not have the above-mentioned problems associated with reaming, but the mechanical stability may limit its application.…”

System evaluation on reamed and non-reamed intramedullary nailing in the treatment of closed tibial fracture

“…Tibia fractures are common orthopedic disease propose that reaming will destroy the blood vessels, increase pressure within the medullary cavity and stimulate the formation of vascular thrombosis [6][7][8][9] . Pfister considers that nonreamed nailing is favored especially in German-speaking countries due to slightly simple operation procedure, but it remains the method of first choice for treatment of a hypertrophic non-union of the shaft of the long bones 10 .…”