Prospective randomized study of reamed versus unreamed femoral intramedullary nailing: An assessment of procedures

Objective: To determine whether the procedure of unreamed femoral nailing i s simpler, faster, and safer than reamed femoral intramedullary nailing. Design: Prospective randomized. Setting/Participants: One hundred femoral shaft fractures without significa nt concomitant injuries admitted to an academic Level I urban trauma center . Intervention: Stabilization of the femoral shaft fracture using a reamed or unreamed technique. Outcome Measurements: The surgical time, estimated blood loss, fluoroscopy time, and perioperative complications were prospectively recorded. Results: One hundred patients with 100 femoral shaft fractures were correct ly prospectively randomized to the study. Thirty seven patients received re amed and sixty-three patients received unreamed nails. All nails were inter locked proximally and distally. The average surgical time fur the reamed na il group was 138 minutes and for unreamed nail group was 108 minutes (p = 0 .012). The estimated blood loss for the reamed nail group was 278 millilite rs and for the unreamed nail group 186 milliliters (p = 0.034). Reamed intr amedullary nailing required an average of 4.72 minutes, whereas unreamed na iling required 4.29 minutes of fluoroscopy time. Seven perioperative compli cations occurred in the reamed nail group and eighteen in the unreamed nail group. Two patients in the unreamed group required an early secondary proc edure. Iatrogenic comminution of the fracture site occurred during three re amed and six unreamed intramedullary nailings. Reaming of the canal was req uired before the successful placement of three nails in the unreamed group because of canal/nail diameter mismatch. Conclusions: Unreamed femoral intramedullary nailing involves fewer steps a nd is significantly faster with less intraoperative blood loss than reamed intramedullary nailing. The unreamed technique, however, was associated wit h a higher incidence of perioperative complications, although the differenc e was not statistically significant (p = 0.5).