title: Reaming does not add significant time to intramedullary nailing of diaphyseal fractures of the tibia and femur.
abstract: BACKGROUND
  Reamed intramedullary nailing is the current gold standard for the treatment of diaphyseal fractures of the femur and tibia. Current concepts of orthopedic damage control surgery for patients with multiple injuries have placed an emphasis on appropriate surgical timing, limiting blood loss, and the duration of the initial operative procedure(s). Proponents of unreamed nailing have stated that reaming places polytraumatized patients "at risk," in part because it adds to the length of the surgical procedure and may exacerbate the severity of a patient's pulmonary injury. The purpose of this study was to determine how many minutes reaming actually takes and what percentage of operative time reaming comprises during intramedullary nailing of femoral and tibial shaft fractures.
  
  
  METHODS
  Intraoperative timing data were collected prospectively on a total of 52 patients with 54 fractures (21 femoral and 33 tibial) who underwent reamed intramedullary nailing of acute closed or open femoral or tibial shaft fractures over a 10-month period. Total operating room, surgical, and reaming times were collected.
  
  
  RESULTS
  The average reaming time for femur and tibia fractures was 6.9 minutes and 7 minutes, respectively. On average, reaming accounted for 4.9% of the surgical time and 3.2% of the total operating room time for femur fractures and 4.9% of the surgical time and 3.4% of the total operating room for tibia fractures.
  
  
  CONCLUSIONS
  Our results show that reaming comprises a small percentage of the operative time and the total time a patient spends in the operating room.
authors.affiliation: Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri 65212, USA. cristb@health.missouri.edu
authors.forename: Brett D
authors.initials: BD
authors.lastname: Crist
authors.forename: Philip R
authors.initials: PR
authors.lastname: Wolinsky
mesh_terms: D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D005596:Fractures, Closed / Q000601:surgery; D005597:Fractures, Open / Q000601:surgery; D006801:Humans; D013978:Tibial Fractures / Q000601:surgery*