Abstract
Reaming intramedullary nailing, possibly associated with autologous bone grafting, is an effective procedure for the treatment of uninfected non-union and limited post-traumatic segmental bony defects. The main purpose of the treatment is to remove the causes responsible for the pathological evolution of fracture healing and to create proper vascular and mechanical conditions in the lesion site.
Hypertrophic non-union, which is considered a biologically active pathological condition, can be effectively treated by reaming of the medullary canal and by introducing a new nail of a larger diameter locked in a dynamic configuration; the purpose of this procedure is to help osteogenic compressive forces at the non-union site. In contrast, for the treatment of atrophic non-union it is necessary to avoid all mechanical stresses on the non-union site and give a new proper biological input. Cancellous and cortical-cancellous autologous bone grafting has undoubtedly well-known osteoinduc-tive and osteoconductive properties as well as introducing new osteogenic bone marrow cells to the non-union site.
Non-union site exposure, essential to remove pathological tissues and to open medullary canal, must be performed by gently dissecting the soft tissues to lower the infection risk and to save the periosteal vascularisa-tion.
The authors report their experience using locked reamed intramedullary nailing combined with cancellous and/or cortical-cancellous autologous bone grafts for the treatment of uninfected non-union, non-biologically active delayed union and limited post-traumatic bony defects in 15 cases. Based on our experience, such a procedure is reliable and with excellent biological and mechanical properties, as all of the lesions healed at the end of the treatment without complications. In these “bone callus” diseases, which always provide clinical and psychological discomfort, this procedure has demonstrated good results and, because of this, in our series, has also been used for the treatment of delayed union.
