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[Systemic complications in intramedullary nailing]

K Wenda1, M Runkel

  • 1Klinik für Unfall- und Wiederherstellungschirurgie, Dr. Horst-Schmidt-Kliniken Wiesbaden.

Der Orthopade
|June 1, 1996
PubMed
Summary

Unreamed intramedullary nailing significantly reduces bone marrow embolization compared to reamed nailing, especially in tibial fractures. This makes unreamed nailing the preferred method for stabilizing femoral and tibial fractures when patient conditions permit.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Management
  • Biomedical Engineering

Background:

  • Intramedullary nailing is the gold standard for femoral and tibial diaphysial fractures.
  • Reaming increases intramedullary pressure, leading to potential bone marrow embolization and systemic complications.
  • The clinical relevance of embolization with restricted reaming and unreamed nails requires further investigation.

Purpose of the Study:

  • To evaluate the clinical relevance of bone marrow embolization during intramedullary nailing.
  • To compare embolization risks between reamed and unreamed nailing techniques.
  • To determine the optimal intramedullary nailing strategy for fracture stabilization.

Main Methods:

  • Experimental investigations and echocardiography were used to assess embolization.
  • Analysis of embolized material during reamed and unreamed femoral and tibial nailing.
  • Evaluation of factors influencing embolization, such as nail insertion velocity and fit.

Main Results:

  • Relevant bone marrow intravasation was observed only in reamed femoral nailing.
  • Tibial nailing showed less embolization due to anatomical differences.
  • Careful insertion of appropriately sized unreamed nails resulted in minimal embolization.

Conclusions:

  • Unreamed intramedullary nailing is the preferred treatment for femoral and tibial fractures when feasible.
  • Systemic complications from embolization are primarily a concern with reamed femoral nailing.
  • External fixation followed by delayed intramedullary nailing is recommended for multitrauma patients in shock.

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