Abstract
Purpose: The purpose of this retrospective analysis over a seven-year period was to evaluate outcome of centromedullary nailing without reaming using the UTN for leg fractures.
Material and methods: A nailing procedure was performed in 106 patients (71 men and 35 women), mean age 38.2 years (16–76); 31.1% had multiple trauma injuries. Fractures were closed (77.4%) or open (22.6%): Gustilo I (n=19), Gustilo II (n=5). The fracture involved the shaft (77.4%), the lower quarter of the tibia (12.2%) or was bifocal (10.3%). There were five cases of vessel injury at diagnosis and two cases of neurological injury. A static assembly was used in all cases. Weight-bearing was resumed after a 6-week period of rest before unlocking.
Results: Mean follow-up was 13.1 months. Bone healing was achieved in 85.8% of the cases in 17 weeks on average. There were five cases of deformed callus (5–10° valgus or varus which did not require surgical revision). Late healing was noted in 7.5% and true nonunion in 6.6% which required either fibular osteotomy to achieve healing (n=6) or insertion of a new nail (Grosse and Kempf, n=1) after reaming. There were ten cases of locking screw fracture. Functional outcome was considered good or very good in 89.6% of patients. Twelve patients presented limited dorsal flexion of the foot and nine had pain at the upper end of the nail.
Discussion: Not reaming offers a clear advantage over reaming, particularly for preservation of endosteal vessels. Unreamed nailing is an interesting alternative to external fixation for open fractures. Despite the absence of infection, we do not have any argument in favour of a solid nail to decrease the risk of infection. The time to healing and the rate of true nonunion were not sufficient to clearly favour this method over reamed nailing.
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