Reaming versus non-reaming in medullary nailing: Interference with cortical circulation of the canine tibia

Klein, Moritz; Rahn, B. A.; Frigg, R.; Kessler, S; Perren, Stephan M.

doi:10.1007/bf00636168

Cited by 287 publications

(106 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the lateral view, a minor correction into flexion with slight anterior translation was achieved as planned recommendation is preservation of the endosteum by cortical osteotomies [83]. Some authors hypothesise that reaming may compromise endosteal blood supply and, thus, affect the quality of the regenerate [135,136]. However, there is evidence that the periosteal blood supply may increase after intramedullary nailing, which is particularly important for effective distraction osteogenesis [76,137].…”

Section: Intramedullary Fixation: General Considerationsmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

View full text Add to dashboard Cite

Any lower limb discrepancy may be equalised by conservative means (insoles, prosthesis and orthosis). However, their long-term acceptance is low in regard to function, costs, expenditure and appearance. Timely epiphysiodesis is the best option in uniplanar deformities with adequate remaining growth and for patients whose predicted final body height is above the 50th percentile. However, many patients present late or with multi-planar deformities, which warrant more sophisticated operative approaches. The history of surgical bone lengthening comprises 100 exciting years of struggling, development and ongoing learning. The initial strategy of acute or rapid incremental distraction had lasted almost half a century until Ilizarov recognised the benefits of biological periosteum-preserving osteotomies and incremental lengthening at slow rates (1 mm/day) at a 4 × 0.25-mm daily rhythm, well appreciated as callotasis. In parallel, ring and wire constructs made complex three-dimensional axial, translational and rotational bone moulding possible. Taylor Spatial Frames—built on hexapod strut-linked platform technology as known from flight simulators—took limb correction to a more reliable, more precise and aesthetical level, all the more that the whole process became web-based. It represents state-of-the-art methodology and technology for complex, multi-plane deformities. Due to the significant risk of secondary malalignment, indications for lengthening by unilateral fixation have shrunken to moderate amounts of length disparity and uni- to bi-planar deformities in patients with still open physes. Mechanical or motorised, minimally invasively placed nails prevent muscle fixation and, therefore, ease rehabilitation, increase patient comfort and potentially shorten the overall time of sick leave and refrain from sports activities. Hence, they offer a valuable alternative for low-grade complexity situations. It remains to be proved if the significantly higher implant costs are compensated by lower treatment costs. Overall, limb lengthening, particularly in combination with multi-planar deformity correction, can still be an arduous endeavour. In any case, wise judgement of the patient’s deformity, medical and biological situation, psychosocial environment, selection of the appropriate method and hardware, as well as meticulous operating technique by an experienced surgeon are the cornerstones of successful outcomes.

show abstract

Section: Intramedullary Fixation: General Considerationsmentioning

confidence: 99%

Current concepts of leg lengthening

Hasler

Krieg

2012

Journal of Children's Orthopaedics

102

View full text Add to dashboard Cite

show abstract

“…Non-union was significantly high in the unreamed rather than reamed group in this study but some studies shows that reamed intramedullary nailing might destroy the nutrient artery, which is the main source of blood for 70% of the tibial cortex would impair fracture healing and increase infection [8,9]. Reamed intramedullary nailing results in increased contact area between the implant and the bone surface and thus increases stability, permitting early weight bearing and eventually facilitating fracture union [10,11].…”

Section: Discussionmentioning

confidence: 70%

Reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures-A comparative study

et al. 2016

Int J of Biomed & Adv Res

View full text Add to dashboard Cite

Tibial fractures were the most common long bone fracture. These were treated by intramedullary nailing. Treatment of reamed versus unreamed intramedullary nailing was still controversial. This comparative study was conducted in the department of orthopaedic surgery in Mahatma Gandhi Memorial Hospital, Warangal, Telangana state, India with an aim to know the efficacy of both treatments. In this study the average duration of surgery was 72±12 min, the average time to full weight-bearing was 9.2 weeks and the average time to union of the fracture was 14 weeks. The unreamed intramedullary nailing group demonstrated a significantly higher rate of fracture non-union (R 3%, U 6%) and malunion (R 6%, U 9%). The significantly higher incidences of implant exchange, a higher risk of screw failure and dynamization were noticed in the unreamed intramedullary nailing group. Regarding the adverse effects like infection, compartment syndrome and knee pain there was no significant difference between two groups.

show abstract

“…This procedure secured axial alignment, maintained length gained, and prevented refracture after external fixator removal. Some authors have expressed concern that intramedullary nailing may compromise the endosteal blood supply of diaphyseal bone and thus affect the quality of newly formed bone during leg-lengthening procedures [8,15,18]. However, it has been shown that the periosteum and surrounding soft tissue can support osteogenesis and permit new bone formation, and it is also known these issues are particularly important for effective distraction osteogenesis [9,19,20].…”

Section: Discussionmentioning

confidence: 99%

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

Kim

Lee

Kim

et al. 2008

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18 tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a nail (10 mm diameter in 17 tibiae and 11 mm in one tibia) in combination. Average limb lengthening was 4.19 cm (range, 2.5-5.5). The mean duration of external fixation was 12.58 days per centimetre gain in length, and the mean consolidation index was 40.53 (range, 35.45-51.85). All distracted segments healed spontaneously without refracture or malalignment. Gradual limb lengthening using a reamed type intramedullary nail and circular external fixation in combination was found to be reliable and effective and reduced external fixation time with fewer complications.

show abstract

Reaming versus non-reaming in medullary nailing: Interference with cortical circulation of the canine tibia

Cited by 287 publications

References 8 publications

Current concepts of leg lengthening

Current concepts of leg lengthening

Reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures-A comparative study

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator

Contact Info

Product

Resources

About