title: Comparison of reamed and nonreamed solid core nailing of the tibial diaphysis after external fixation: a preliminary report.
abstract: From July 1982 to March 1990, 32 patients had an external fixator applied to treat a tibial diaphyseal fracture and subsequently underwent intramedullary nailing: 16 with reamed and 16 with nonreamed solid core nails. Indications for surgery were 12 atrophic and 1 hypertrophic nonunion in each group. The balance were either planned conversions or inadequate external fixators due to head injuries. All but one were seen by an author at a minimum of 1 year. Among the reamed nails, 3 fractures were grade III B. Two patients had pin tract infections, and there were no prenail wound infections. All infections were clinically inactive at the time of nail insertion. Postnail, 7 patients became infected, requiring 12 debridements and 2 procedures to achieve union. One patient had a plate applied 44 weeks postnail and was lost 48 weeks postnail with a persistent infected nonunion. The average time to union was 26 weeks. In the nonreamed solid core group, 2 fractures were grade III A and 5 grade III B. There were 2 pin and 5 prenail wound infections. One nail was inserted across an active pin tract infection. One tibia became infected postnail (p = .04). The fractures united at an average of 14 weeks postnail (p = .036). Two debridements to control infection but no further procedures to achieve union were necessary (p = .003). When tibial reconstructions following external fixation are required, nonreamed solid core nails are efficacious and may be preferable to reamed nails.
authors.affiliation: Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
authors.forename: B L
authors.initials: BL
authors.lastname: Riemer
authors.forename: S L
authors.initials: SL
authors.lastname: Butterfield
mesh_terms: D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D003646:Debridement; D016267:External Fixators; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation*; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000601:surgery; D013978:Tibial Fractures / Q000601:surgery*; D014946:Wound Infection / Q000601:surgery