Early changes in nutrient artery blood flow following tibial nailing with and without reaming: A preliminary study

Objective: To quantify the changes in nutrient artery blood flow following reamed and unreamed nailing of intact canine tibias. Design: In vivo animal study. Intervention: Eighteen dogs underwent nutrien t artery blood flow measurements over a fourteen-day period. The interventi on groups consisted of controls (Group I), nailing without reaming (Group I I), and nailing with reaming (Group III). Main Outcome Measurements: Nutrient artery blood flow was measured through implantable ultrasonic blood flow probes placed around the nutrient artery of the tibia. Results: Nutrient artery blood flow averaged 1.94 milliliters per minute ov er the fourteen-day period in Group I (no reaming or nailing performed). Nu trient artery blood flow following nailing without reaming (Group II) decre ased to 44 percent of baseline values immediately after the procedure. By p ostoperative day 1, flow had decreased to 23 percent of baseline; over the fourteen-day period, nutrient artery blood flow recovered toward baseline v alues. Immediately following nailing with reaming (Group III), nutrient art ery blood flow measured zero milliliters per minute. Over the fourteen-day period, nutrient artery blood flow in this group averaged 39 percent of the baseline level (range 19 to 58 percent). Whereas nutrient artery blood flo w recovered toward baseline values (99 percent of baseline) by fourteen day s in Group II, nutrient artery blood flaw measured only 26 percent of the b aseline level on postoperative day fourteen in Group III. Conclusions: The preliminary data suggest that nailing with reaming provide s a double insult to the nutrient artery distribution.