Non-reamed versus Reamed Intramedullary Nailing for Tibial Fractures in Adults: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

PENG Bin ¹ , TIAN He ² , WU Taixiang ³

1. Postgraduate 2003, Xinjiang Medical University, Urumqi 830054, China2. The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China3. Chinese Evidence-Based Medicine Center/ Clinical Epidemiology Resource and Training Centre, West China Hospital, Sichnan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Tibial fractures; Fracture fixation; Intramedullary; Randomized controlled trials; Systematic review

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Objective 　To determine the effect of non-reamed versus reamed intramedullary nailing for tibial fractures in adults on the rates of nonunion, the rates of implant failure, the rates of infection, the incidence of compartment syndrome, the rates of malunion, and the time of union.
Methods 　We searched MEDLINE （1966 -July, 2005）, EMBASE （1974 -July, 2005 ）, The Cochrane Library （Issue 2, 2005 ）and CBMdisc （1979 -July, 2005 ）, and handsearched the relevant Chinese and English orthopedic journals. Randomized controlled trials and Clinical controlled trials of nonreamed versus reamed intramedullary nailing for tibial fractures in adults were included. The quality of trials was critically assessed. RevMan 4.2.7 software was used for data analysis.
Results 　Four RCTs and one CCT of non-reamed versus reamed intramedullary nailing for tibial fractures in adults were included. The results of meta-analysis showed that nonreamed intramedullary nailing for tibial fractures in adult increased the rates of nonunion （RR 1.87, 95% CI 1.20 to 2. 91, P =0. 006）, implant failure （RR 2.23, 95% CI 1.49 to 3.34, P〈0. 000 1 ） and the time to union （WMD 9.00, 95% CI 3.19 to 14.81, P =0. 002）.
Conclusions 　Compared with reamed intramedullary nailing for tibial fractures in adults, non-reamed intramedullary nailing increases the rates of nonunion and implant failure is common. There is no statistical difference in the rates of post operative infection, the rates of malunited fracture and the incidence of compartment syndrome between the two groups. However, further studies are needed to determine the effects of reamed and non-reamed intramedullary nailing on these outcomes, expecially when patient has severe open fractures （Gustilo Grade Ⅲ C）and multiple injuries.

Citation： PENG Bin,TIAN He,WU Taixiang. Non-reamed versus Reamed Intramedullary Nailing for Tibial Fractures in Adults: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(10): 778-785. doi: Copy

1.	Court-Brown CM,Christie J,McQueen MM.Closed intramedullary tibial nailing.Its use in closed and type I open fractures[J].J Bone Joint Surg Br,1990;72(4):605-611.
2.	Ekeland A,Thoresen BO,Alho A,Stromsoe K,Folleras G,Haukebo A.Interlocking intramedullary nailing in the treatment of tibial fractures:a report of 45 cases[J].Clin Orthop,1988;(231):205-215.
3.	Bone LB,Johnson KD.Treatment of tibial fractures by reaming and intramedullary nailing[J].J Bone Joint Surg,1986;68(6):877-887.
4.	Reichert IL,McCarthy ID,Hughes SP.The acute vascular response to intramedullary reaming:microsphere estimation of blood flow in the intact ovine tibia[J].J Bone Joint Surg Br,1995;77(3):490-493.
5.	Klein MP,Rahn BA,Frigg R,Kessler S,Perren SM.Reaming versus non-reaming in medullarynailing:interference with cortical circulation of the canine tibia[J].Arch Orthop Trauma Surg,1990;109(6):314-316.
6.	Schemitsch EH,Kowalski MJ,Swiontkowski MF,Harrington RM.Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia[J].J Orthop Res,1995;13(3):382-389.
7.	Melcher GA,Hauke C,Metzdorf A,Perren SM,Printzen G,Schlegel U,Ziegler WJ.Infection after intramedullarynailing:an experimental investigation on rabbits[J].Injury,1996;27(suppl3):23-26.
8.	Kessler SB,Hallfeldt KK,Perren SM,Schweiberer L.The effects of reaming and intramedullary nailing on fracture healing[J].Clin Orthop,1986;(212):18-25.
9.	Gregory P,Sanders R.The treatment of closed,unstable tibial fractures with undreamed interlocking nails[J].Clin Orthop,1995;(315):48-55.
10.	Rhinelander FW.Tibial blood supply in relation to fracture healing[J].Clin Orthop,1974;105(0):34-81.
11.	Schemitsch EH,Kowalski MJ,Swiontkowski MF,Harrington RM,Senft D.Effects of reamed versus unreamed locked nailing on callus blood flow and early strength of union in a fractured sheep tibia model[J].Orthop Trans,1994;18(2):145.
12.	Sitter T,Wilson J,Browner B.The effect of reamed vs unreamed nailing on intramedullary blood supply on cortical viability[abstract][J].J Orthop Trauma,1990;4(3):232.
13.	Anglen JO,Blue JM.A comparison of reamed and unreamed nailing of the tibia[J].J Trauma,1995;39(2):351-355.
14.	Blachut PA,O’Brien PJ,Meek RN,Broekhuyse HM.Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft:a prospective,randomized study[J].J Bone Joint Surg,1997;79(5):640-646.
15.	Court-Brown CM,Will E,Christie J,McQueen MM.Reamed or unreamed nailing for closed tibial fractures:a prospective study in Tscherne C1 fractures[J].J Bone Joint Surg,1996;78(4):580-583.
16.	Finkemeier CG,Schmidt AH,Kyle RF,Templeman DC,Varecka TF.A prospective randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft[J].J Orthop Trauma,2000;14(3):187-193.
17.	Keating JF,O’Brien PJ,Blachut PA,Meek RN,Broekhuyse HM.Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft:a prospective,randomized study[J].J Bone Joint Surg,1997;79(3):334-341.
18.	Mayr E,Barnikel C,Braun W,Ruter A.Closed tibial fractures reamed or unreamed intramedullary nailing:A clinical study[J].Zentralbl Chir,1995;120(1):24-30.
19.	Ruchholtz S,Nast-Kolb D,Betz A,Schweiberer L.Fracture healing after intramedullary nailing of simple tibial shaft fractures.A clinical comparison of reamed and unreamed procedures[J].Unfallchirurg,1995;98(7):369-375.
20.	Leif B(o\/)rge Larsen,Madsen JE.Hoiness PR.Ovre S.Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective,randomized study with 3.8 years follow-up[J].J Orthop Trauma,2004;18(3):144-149.
21.	Beadel G,McKee J.Reamed versus unreamed tibial nails.A prospective randomised trial[J].J Bone Joint Surg Br,2002;84B (Suppl Ⅱ):132.
22.	Alderson P,Green S,Higgins JPT,editors.Cochrane Reviewers Handbook 4.2.1[updated December 2003].Section 6.In:The Cochrane Library.The Cochrane Collaboration.Oxford:2004,Issue 1.
23.	Moher D,Cook DJ,Eastwood S,Olkin I,Rennie D,Stroup DF.For the QUOROM group:Improving the quality of reports of Mata-analyses of randomized controlled trials:the QUOROM statement[J].Lancet,1999;354(9193):1896-1900.
24.	Arazi M,Ogun TC,Oktar MN,Memik R,Kutlu A.Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures:is it a safe procedure[J].J Trauma,2001;50(4):711-716.
25.	Fotster MC,Bruce AS,Aster AS.Should the tibia be reamed when nailing[J].Injury,2005;36(3):439-444.
26.	Pape HC,Dwenger A,Regel G,Schweitzer G,Jonas M,Remmers D,Krumm K,Neumann C,Sturm JA,Tscherne H.Pulmonary damage after intramedullary femoral in traumatized sheep:Is there an effect from different nailing methods[J].J Trauma,1992;33(4):574-581.
27.	Manning JB,Bach AW,Herman CM,Carrico CJ.Fat release after femur nailing in the dog[J].J Trauma,1983;23(4):322-326.
28.	Wolinsky PR,Banit D,Parker RE,Shyr Y,Snapper JR,Rutherford EJ,Johnson KD.Reamed intramedullary femoral nailing after induction of an "ARDS-like" state in sheep:effect on clinically applicable markers of pulmonary function[J].J Orthop Trauma,1998;12(3):169-176.
29.	Nassif JM,Gorczyca JT,Cole JK,Pugh KJ,Pienkowski D.Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures:a randomized prospective study[J].J Orthop Trauma,2000;14(8):554-558.

1. Court-Brown CM,Christie J,McQueen MM.Closed intramedullary tibial nailing.Its use in closed and type I open fractures[J].J Bone Joint Surg Br,1990;72(4):605-611.
2. Ekeland A,Thoresen BO,Alho A,Stromsoe K,Folleras G,Haukebo A.Interlocking intramedullary nailing in the treatment of tibial fractures:a report of 45 cases[J].Clin Orthop,1988;(231):205-215.
3. Bone LB,Johnson KD.Treatment of tibial fractures by reaming and intramedullary nailing[J].J Bone Joint Surg,1986;68(6):877-887.
4. Reichert IL,McCarthy ID,Hughes SP.The acute vascular response to intramedullary reaming:microsphere estimation of blood flow in the intact ovine tibia[J].J Bone Joint Surg Br,1995;77(3):490-493.
5. Klein MP,Rahn BA,Frigg R,Kessler S,Perren SM.Reaming versus non-reaming in medullarynailing:interference with cortical circulation of the canine tibia[J].Arch Orthop Trauma Surg,1990;109(6):314-316.
6. Schemitsch EH,Kowalski MJ,Swiontkowski MF,Harrington RM.Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia[J].J Orthop Res,1995;13(3):382-389.
7. Melcher GA,Hauke C,Metzdorf A,Perren SM,Printzen G,Schlegel U,Ziegler WJ.Infection after intramedullarynailing:an experimental investigation on rabbits[J].Injury,1996;27(suppl3):23-26.
8. Kessler SB,Hallfeldt KK,Perren SM,Schweiberer L.The effects of reaming and intramedullary nailing on fracture healing[J].Clin Orthop,1986;(212):18-25.
9. Gregory P,Sanders R.The treatment of closed,unstable tibial fractures with undreamed interlocking nails[J].Clin Orthop,1995;(315):48-55.
10. Rhinelander FW.Tibial blood supply in relation to fracture healing[J].Clin Orthop,1974;105(0):34-81.
11. Schemitsch EH,Kowalski MJ,Swiontkowski MF,Harrington RM,Senft D.Effects of reamed versus unreamed locked nailing on callus blood flow and early strength of union in a fractured sheep tibia model[J].Orthop Trans,1994;18(2):145.
12. Sitter T,Wilson J,Browner B.The effect of reamed vs unreamed nailing on intramedullary blood supply on cortical viability[abstract][J].J Orthop Trauma,1990;4(3):232.
13. Anglen JO,Blue JM.A comparison of reamed and unreamed nailing of the tibia[J].J Trauma,1995;39(2):351-355.
14. Blachut PA,O’Brien PJ,Meek RN,Broekhuyse HM.Interlocking intramedullary nailing with and without reaming for the treatment of closed fractures of the tibial shaft:a prospective,randomized study[J].J Bone Joint Surg,1997;79(5):640-646.
15. Court-Brown CM,Will E,Christie J,McQueen MM.Reamed or unreamed nailing for closed tibial fractures:a prospective study in Tscherne C1 fractures[J].J Bone Joint Surg,1996;78(4):580-583.
16. Finkemeier CG,Schmidt AH,Kyle RF,Templeman DC,Varecka TF.A prospective randomized study of intramedullary nails inserted with and without reaming for the treatment of open and closed fractures of the tibial shaft[J].J Orthop Trauma,2000;14(3):187-193.
17. Keating JF,O’Brien PJ,Blachut PA,Meek RN,Broekhuyse HM.Locking intramedullary nailing with and without reaming for open fractures of the tibial shaft:a prospective,randomized study[J].J Bone Joint Surg,1997;79(3):334-341.
18. Mayr E,Barnikel C,Braun W,Ruter A.Closed tibial fractures reamed or unreamed intramedullary nailing:A clinical study[J].Zentralbl Chir,1995;120(1):24-30.
19. Ruchholtz S,Nast-Kolb D,Betz A,Schweiberer L.Fracture healing after intramedullary nailing of simple tibial shaft fractures.A clinical comparison of reamed and unreamed procedures[J].Unfallchirurg,1995;98(7):369-375.
20. Leif B(o\/)rge Larsen,Madsen JE.Hoiness PR.Ovre S.Should insertion of intramedullary nails for tibial fractures be with or without reaming? A prospective,randomized study with 3.8 years follow-up[J].J Orthop Trauma,2004;18(3):144-149.
21. Beadel G,McKee J.Reamed versus unreamed tibial nails.A prospective randomised trial[J].J Bone Joint Surg Br,2002;84B (Suppl Ⅱ):132.
22. Alderson P,Green S,Higgins JPT,editors.Cochrane Reviewers Handbook 4.2.1[updated December 2003].Section 6.In:The Cochrane Library.The Cochrane Collaboration.Oxford:2004,Issue 1.
23. Moher D,Cook DJ,Eastwood S,Olkin I,Rennie D,Stroup DF.For the QUOROM group:Improving the quality of reports of Mata-analyses of randomized controlled trials:the QUOROM statement[J].Lancet,1999;354(9193):1896-1900.
24. Arazi M,Ogun TC,Oktar MN,Memik R,Kutlu A.Early weight-bearing after statically locked reamed intramedullary nailing of comminuted femoral fractures:is it a safe procedure[J].J Trauma,2001;50(4):711-716.
25. Fotster MC,Bruce AS,Aster AS.Should the tibia be reamed when nailing[J].Injury,2005;36(3):439-444.
26. Pape HC,Dwenger A,Regel G,Schweitzer G,Jonas M,Remmers D,Krumm K,Neumann C,Sturm JA,Tscherne H.Pulmonary damage after intramedullary femoral in traumatized sheep:Is there an effect from different nailing methods[J].J Trauma,1992;33(4):574-581.
27. Manning JB,Bach AW,Herman CM,Carrico CJ.Fat release after femur nailing in the dog[J].J Trauma,1983;23(4):322-326.
28. Wolinsky PR,Banit D,Parker RE,Shyr Y,Snapper JR,Rutherford EJ,Johnson KD.Reamed intramedullary femoral nailing after induction of an "ARDS-like" state in sheep:effect on clinically applicable markers of pulmonary function[J].J Orthop Trauma,1998;12(3):169-176.
29. Nassif JM,Gorczyca JT,Cole JK,Pugh KJ,Pienkowski D.Effect of acute reamed versus unreamed intramedullary nailing on compartment pressure when treating closed tibial shaft fractures:a randomized prospective study[J].J Orthop Trauma,2000;14(8):554-558.

Chinese Journal of Evidence-Based Medicine

Non-reamed versus Reamed Intramedullary Nailing for Tibial Fractures in Adults: A Systematic Review

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