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Thursday, March 1, 2001

'Reamed-to-fit' and unreamed success rate comparable

A retrospective study of "reamed-to-fit" and unreamed nailing in open fractures, presented in poster exhibit 72, found that the healing of open tibial fractures using either reamed or unreamed nailing is comparable. "Previous literature suggested a higher rate of infection using reamed technique and discouraged this practice," say the coauthors of the study.

"This increase was not seen with the ream-to-fit technique. Further, the number of secondary procedures needed with the unreamed technique was significantly greater than with ream-to-fit technique; these additional procedures translate into increased cost of treatment. The use of a reamer to 'sound' the canal and allow placement of a larger nail does not appear to be deleterious and may have beneficial effects, both clinically and financially." The investigators used a prospectively designed, surgeon-controlled protocol. All open tibia fractures over a four-year period were treated with one of two treatment protocols; one group of surgeons placed unreamed tibial nails (R), while the other group used a minimally reamed technique (NR). Medical records and serial radiographs were evaluated for demographic and perioperative data, clinical and radiographic healing, postoperative complications, and the need for secondary intervention to achieve union. Global cost differences between the protocols were determined.

Statistical analysis was done using a Fishers Exact test. Results: The reamed group had 22 patients [(15 males, 7 females) mean age 38 (range:17-69)]. The unreamed group had 29 patients [(23 males, 6 females) mean age 40 (range:15-76)]. No significant differences in demographics, mechanism of injury, severity of fracture, fracture type, or other perioperative data were found. Twenty-one of 22 patients (95 percent) in the reamed group healed and 28 of 29 patients (96 percent) in the unreamed group healed. There was no statistically significant difference in the healing rates of the two groups.

The unreamed group required significantly more supplemental procedures than the reamed group to achieve union (R=10, NR=32, p<0.05). A second intervention was required for nine of 22 patients (41 percent) of the reamed group and 20 of 29 patients (69 patients) of the unreamed group. A third procedure was required for 8 of 29 patients (28 percent) of the unreamed group and only one of 22 (4 percent) of the reamed group. One patient in the unreamed group required four procedures, another required six to achieve union.

Infection occurred in two of 22 patients (9 percent) of the reamed group and seven of 29 patients (25 percent) of the non-reamed group, (p=NS) The average cost of using the reamed technique was approximately $4,900 per fracture less ($8,500 vs. $3,600) when comparing the normalized cost for each method of nailing.

Coauthors of the study are Brian A. Klatt, MD; Bruce H. Ziran, MD; and Michael Darowish, all of the deparrment of orthopaedic surgery, University of Pittsburgh, Pa.

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Last modified 14/February/2001 by IS