title: The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures.
abstract: BACKGROUND
  Stabilisation of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this study was to determine the incidence of non-union following unreamed intramedullary stabilisation of femoral fractures. Secondary objectives were intra- and postoperative complications and implant failure.
  
  
  METHODS
  Between March 1995 and June 2005, 125 patients with 129 traumatic femoral shaft fractures were treated with as unreamed femoral nail. From this retrospective single centre study, 18 patients were excluded due to insufficient follow up data, including 1 patient who died within 2 days after severe head injury. Sixty-six patients had suffered multiple injuries. 21 fractures were open. According to the AO classification, there were 54 type A, 42 type B, and 14 type C fractures. Dynamic proximal locking was performed in 44 cases (36 type A and 8 type B fractures).
  
  
  RESULTS
  Non-union occurred in two patients (1.9%; one type B and one type C fractures). Intra-operative complications were seen in three patients (2.8%). Postoperative in-hospital complications occurred in 29 patients (27%). Local superficial infection occurred in two patients (1.9%), there were no cases of deep infection. Implant failure occurred in three patients (2.8%): nail breakage was seen in two patients.
  
  
  CONCLUSIONS
  In this study, the incidence of non-union following unreamed intramedullary nailing is low (1.9%) and comparable with the best results of reamed nailing in the literature.
authors.affiliation: Department of Traumatology, University Medical Centre Groningen, Groningen, The Netherlands. m.el.moumni@chir.umcg.nl
authors.forename: M
authors.initials: M
authors.lastname: el Moumni
authors.forename: P A
authors.initials: PA
authors.lastname: Leenhouts
authors.forename: H J
authors.initials: HJ
authors.lastname: ten Duis
authors.forename: K W
authors.initials: KW
authors.lastname: Wendt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult