Leg tissue perfusion in simple tibial shaft fractures treated with unreamed and reamed nailing.
BACKGROUND
To compare the effects of unreamed and reamed intramedullary nailing on tibialis posterior, dorsalis pedis, and sum (tibialis posterior plus dorsalis pedis) distal arterial peak pulses. Additionally, leg skin temperature and transcutaneous oxygen tension were measured in patients with low energy, closed tibial shaft fractures.


METHODS
The patients were randomized to unreamed and reamed groups, and intramedullary nailing without or with reaming was performed under spinal anesthesia. The measurements were carried out before the operation and on 5 postoperative days.


RESULTS
In the unreamed group, the only significant difference between contralateral and nailed legs was in raised leg skin temperature (p = 0.0001). In the reamed group, tibialis posterior distal arterial peak pulses and transcutaneous oxygen tension remained at a significantly lower level and leg skin temperature at a significantly higher level, respectively, in the nailed legs after the operation when compared with contralateral legs (p = 0.0026, p = 0.0001, and p = 0.0001, respectively). There were no statistical differences between preoperative and postoperative values in the measured parameters in both groups. Additionally, there were no intergroup changes in the measured parameters in the injured legs.


CONCLUSIONS
The present study suggests that altered distal arterial pulsations, decreased transcutaneous oxymetry values, and thermal reaction are not due to differences in nailing method but caused by a manifestation of the trauma mechanism of the tibial shaft fracture. The potentially negative effects of reaming to soft tissue perfusion parameters could not be established.
Lindström
T
T
Department of Surgery, University of Turku, Finland.
Gullichsen
E
E
Lertola
K
K
Niinikoski
J
J
D000328:Adult; D001785:Blood Gas Monitoring, Transcutaneous; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012881:Skin Temperature; D013978:Tibial Fractures / Q000503:physiopathology* / Q000601:surgery*