Reamed Versus Unreamed Intertrochanteric Femur Fractures, Is It Time?

Abstract

Objectives: This study compares the intraoperative and postoperative outcomes of the traditional technique of femoral canal reaming to placement of an unreamed 10-mm nail. Design: Retrospective cohort study. Setting: Academic Level I Trauma Center, Southeastern US. Patients/Participants: Intertrochanteric femur fractures treated with a CMN (January 2016–December 2018) were retrospectively identified. Inclusion criteria were as follows: low-energy mechanism, at least 60 years of age, and long CMN. Exclusion criteria were as follows: short CMN, polytrauma, and subtrochanteric fractures. Outcome Measurements: Records were reviewed for demographics, hematologic markers, transfusion rates, operative times, and postoperative complications. Variables were assessed with a χ2 or Student T-test. Significance was set at 0.05. Results: Sixty-five patients were included (37 reamed and 28 unreamed), with a mean age of 76.2 years and mean body mass index of 25.1. Between the reamed and unreamed groups, respectively, mean nail size was 11.0 (SD 1.1) and 10.0 (SD 0.0), P < 0.001; mean blood loss was 209.1 mL (SD 177.5) and 195.7 mL (SD 151.5), P = 0.220; 55% (21/38), and 43% (12/28) were transfused, P = 0.319; operative time was 98.2 (SD 47.3) and 81.5 minutes (SD 40.7); P = 0.035. Changes in hemoglobin/hematocrit were not significant between the study groups. Two patients from the reamed group experienced implant failure due to femoral head screw cut out and returned to the operating room. Two patients from the unreamed group returned to operating room for proximal incision infection, without implant removal. One reamed patient and 2 unreamed patients died before 6-month follow-up. Conclusions: Unreamed CMNs for geriatric intertrochanteric femur fractures provide shorter operative times with no difference in perioperative complications. Both reamed and unreamed techniques are safe and effective measures for fixation of these fractures. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Early myocardial damage (EMD) and valvular dysfunction after femur fracture in pigs

“…In earlier studies in geriatric patients, no significant differences in blood loss, the need of transfusion or haemoglobin/haematocrit were detected between reamed and unreamed femoral fractures. While a significant shorter duration of operation was needed in the unreamed group, both techniques showed satisfactory results in stabilization 29 . In addition, treatment with RIA I showed a relevant blood loss in 3.22% of patients, which needed transfusion 30 .…”

Extracorporeal measurement of femoral nail length in the treatment of trochanteric hip fractures: the “box” technique

“…[ 24 ] The use of 10 mm diameter nails has also obviated the need for reaming the canal in trochanteric fractures, with no significant difference in perioperative and postoperative outcomes compared with reamed nailing in 37 patients. [ 25 ] There were no cases of anterior cortical penetration in the unreamed group. [ 25 ]…”

“…A recent retrospective study showed 10 mm nails to be of adequate strength, regardless of femoral canal length, to promote healing in 147 patients with femoral shaft fractures [24] . The use of 10 mm diameter nails has also obviated the need for reaming the canal in trochanteric fractures, with no significant difference in perioperative and postoperative outcomes compared with reamed nailing in 37 patients [25] . There were no cases of anterior cortical penetration in the unreamed group [25] …”

“…In this study we did not measure surgical time or cost; however, the “box” technique may affect both parameters favorably. Unreamed intramedullary nailing has been demonstrated to save an average of 16.7 minutes of surgical time [25] . Furthermore, the “box” technique saves additional time by avoiding the use of an intramedullary guidewire and depth gage.…”

Literature review on the management of simultaneous bilateral extracapsular hip fractures in the elderly

“…The specific surgical risk associated with reaming in unilateral hip fracture in the elderly has been mentioned recently in the literature. Pitts et al, 36 in a retrospective comparative study of 65 elderly patients with hip fractures, reported shorter operative time for the nonreamed group (16 min on average), without other significant differences in intraoperative blood loss, trans-fusion requirements, hospital stay, failure of osteosynthesis, postoperative complications, and death. In the authors' experience with patients sustaining bilateral hip fractures, they usually ream the femur treated with a long nail to decrease the risk of intraoperative fracture, and they treat the contralateral fracture with a short nonreamed nail to minimize the risks associated with a bilateral reaming procedure.…”