Journal of Musculoskeletal Trauma

Reamed versus Unreamed Interlocking Intramedullary Nailing in the Treatment of Femoral and Tibial Shaft Fracture: Sung Soo Kim, Chul Hong Kim, Myung Jin Lee, Jin Hun Kang; J Korean Fract Soc 2006;19(2):141-146. Published online April 30, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.2.141

Abstract: PURPOSE
To comparative analysis of clincal difference between reamed and unreamed interlocking intramedullary nailing in the treatment of femoral and tibial shaft fractures.
MATERIALS AND METHODS
We reviewed femoral and tibial shaft fracture who were treated with reamed or unreamed nail. They were followed for a minimum of 16 months. Winquist-Hansen and Johner-Wruhs criteria were applied for the classification of the fractures. Retrospectively we evaluated the duration of operation, the amount of bleeding, the first time of callus formation, union time, the time of partial weight bearing, isthmic ratio, complications.
RESULTS
The average duration of operation for femoral fractures with reamed and unreamed nail were 104 minutes, 95 minutes, respectively. And those for tibial fractures were 96 minutes, 87 minutes, and the difference was statistically significant (p<0.05). The amount of bleeding in femoral fractures with reamed and unreamed nail were 360 ml, 223 ml, respectively. And those in tibial fractures were 280 ml, 205 ml, respectively, and the difference was statistically significant (p<0.001). The isthmic ratio in femoral fracture with reamed and unreamed nail were 105.5%, 87.0%, respectively and those in tibial fracture were 106.3%, 85.3%, respectively. There were 2 delayed unions in femoral fractures and 1 delayed union in tibial fracture with unreamed nail, and 1 metal failure in tibial fracture with unreamed nail.
CONCLUSION
Unreamed femoral intramedullary nailing involves fewer steps and less intraoperative blood loss than reamed nailing. There was no statistical difference the first time of callus formation, union time, the time of partial weight bearing. It must be consider that delayed union and metal failure in the unreamed intramedullary nailing due to high grade fracture, lower isthmic ratio, combined with multiple trauma.

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Treatment of Open Tibial Shaft Fractures using Unreamed Nailing: Jong Keon Oh, Chang Wug Oh, Kwon Jae Roh, Duk Moon Chung; J Korean Fract Soc 2005;18(1):22-28. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.22

PURPOSE
To report the results of unreamed nailing using a nail with the largest possible diameter for the management of the open tibial shaft fractures.
MATERIALS AND METHODS
Nineteen patients with open tibial shaft fractures underwent unreamed nailing with the largest possible diameter according to the isthmic diameter measured on preoperative radiography. There were 1 Grade I, 6 Grade II, 9 Grade IIIa, 3 Grade IIIb open fractures. There were 4 type A, 12 type B, 3 type C fractures according to the OTA classification. Fractures were classified as The nail was introduced after gentle passage of a 7 to 8 millimeter-hand reamer.
RESULTS
Union was obtained in all cases. However 9 (47%) fractures required an additional procedures before union. In 6 cases, dynamization was done. Two of them were required exchange nailing for nonunion, 1 of two gained bony union through additional bone graft. Three of the others had gained union through exchange nailing, bone graft, bone transport respectively. There were one rotational malunion, one superfical and one deep infection. Interlocking screw breakage developed only in one patient.
CONCLUSION
Our data indicate that unreamed nailing in the management of open tibial fractures is safe and reliable method. Using a tight fitting nail with the largest possible diameter is a safe and effective way to avoid the problems of screw breakage.

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Treatment of Type IIIb Open Tibial Fractures
Seong Yeon Lim, Il Jae Lee, Jae Ho Joe, Hyung Keun Song
Journal of the Korean Fracture Society.2014; 27(4): 267. CrossRef
Management of Open Tibial Fractures: Role of Internal Fixation
Yerl-Bo Sung
Journal of the Korean Fracture Society.2007; 20(4): 349. CrossRef

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Grade III Tibia Open Fractures Treated with Unreamed Tibial Nailing: Chang Wug Oh, Hee Soo Kyung, Do Heon Kim, Il Hyung Park, Poong Taek Kim, Joo Chul Ihn, Yeon Ki Woo, Jung Yup Lee; J Korean Fract Soc 2004;17(2):148-152. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.148

Abstract PDF

PURPOSE
This is a retrospective study to analyze the results of unreamed intramedullary nailing in grade III tibial open fracture.
MATERIALS AND METHODS
Twenty-nine Gustilo-Anderson grade III tibial open fractures fixed with unreamed tibial nail were followed more than one year. Primary union rate, union time, infection, conversion to external fixation, ankle and knee function according to different grade of open, fracture level, AO classification, and muscle flap were evaluated.
RESULTS
Primary union was achieved at sixteen fractures. There were three delayed union that achieved union twenty week after primary operation. And eight undergone secondary bone grafts which were done after inflammation sign subcided. Complications about infection were in five cases. Two cases were unable to maintain internal fixation due to deep infection, and three of superficial infection were treated with repeated debridement and antibiotics use.
CONCLUSION
In grade III tibial open fracture, unreamed nailing with early soft tissue reconstruction and early prophylactic bone graft can be a good treatment.

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Management of Open Fracture
Gu-Hee Jung
Journal of the Korean Fracture Society.2010; 23(2): 236. CrossRef
Management of Open Tibial Fractures: Role of Internal Fixation
Yerl-Bo Sung
Journal of the Korean Fracture Society.2007; 20(4): 349. CrossRef

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Analysis of Prognostic Factors for Union Time after Unreamed Femoral Nailing: Oog Jin Shon, Won Je Lee; J Korean Fract Soc 2004;17(1):13-18. Published online January 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.1.13

Abstract PDF

PURPOSE
To assess the evaluation of prognostic factors according to union time after unreamed femoral nailing.
MATERIALS AND METHODS
From Mar. 1998 to Mar. 2002, 53 cases of bone healing were analyzed among the fifty-nine femoral shaft fractures were treated with unreamed femoral nail (AO, UFN) and had been followed for more than 12 months. Clinical bone healing time was analyzed by Kempf's method and were evaluated prognostic factors according to union time.
RESULTS
Mean duration of the bone healing time was 18.7 weeks. According to Denker's classification, functional results were seen over satisfactory at all cases. Bone healing time was more faster at the low communition group than high communition group at 18.1 weeks. At the middle portion, bone healing time was fastest. Closed reduction cases were more faster than open reduction cases at 17.9 weeks. Bone healing time was faster that fracture was more close distance from isthmic portion. Bone healing time was not influenced age, isthmic ratio, operation time, associated injury.
CONCLUSION
All cases were unioned within 5 months without severe complication. That was seen faster bone healing time, in that low communition, more close distance of fracture from the isthmic portion, closed reduction method.

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Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult
Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim
Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef

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A Comparative Study of Reamed and Unreamed Nail for Femoral Shaft Fracture's Treatment: Hee gon Park, Myoung ho Kim, Mun jib Yoo, Woo sup Byun; J Korean Soc Fract 2003;16(2):169-176. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.169

Abstract PDF: PURPOSE
The comparative analysis of clinical difference between the use of reamed nail and unreamed nail in treatment of femoral shaft fracture.
MATERIALS AND METHODS
In 105 patients with femoral shaft fracture who were treated with reamed nail or unreamed nail between June of 1997 and April of 2000, 95 patients who underwent more than a year of follow-up were selected. Winquist-Hansen criteria was applied for the classification of fracture. Based on the medical records and radiological examinations, conducted a retrospective, statistical analysis of the duration of operation, the amount of bleeding during operation, the first time of callus formation, union time, and complications.
RESULTS
The average duration of operation was 107 minutes for reamed nail group, and 94 minutes for unreamed nail group, and the difference was statistically significant (p<0.005). The amount of bleeding during the operation was 400 mL for reamed nail group and 250 mL for unreamed nail group, and the difference was statistically significant (p<0.001). There was no statistical difference in the first time of callus formation and union time between the two groups but, in general union time tend to be long in unreamed nail group.
CONCLUSION
In the treatment of femoral shaft fracture, the use of unreamed nail was shown to have an advantage over the use of reamed nail in terms of the duration of operation and the amount of bleeding. We recommend restrictive cases.

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Unreamed interlocking nailing in tibia fracture: You Sung Suh, Young Il Cho, Ho Won Jung, Yeon Il Kim; J Korean Soc Fract 2002;15(4):470-476. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.470

Abstract PDF: PURPOSE
To evaluate of clinical results and malunion according to nail insertion site and early ambulation after unreamed interlocking intramedullary nailing for the treatment of tibial fractures, MATERIALS AND METHODS: We reviewed 46 tibial fractures that were treated with unreamed static intramedullary nailing prospectively from March 1997 to May 2001. Nail insertion site and angulation of fracture site were reviewed by radiograph. All of 46 cases, ambulation was started at postoperative 2 weeks, and then clinical outcomes were reveiwed RESULTS: In all 46 cases, union was achieved at average 18.2 weeks clinically and average 19.4 weeks radiographically. There is no significant difference in angulation according to nail insertion site, i,.e. after central/medial/lateral insertion, outcome was 2 . 4 5 degrees +/-2 . 1 7 / 2 . 2 2 degrees +/-1 . 8 4 / 1 . 7 3 degrees +/-1.33(p; 0.705) in last follow up anterioposterior view, and 1.81 degrees +/-1 . 1 3 / 2 . 6 7 degrees +/-1 . 6 2 / 2 . 0 0 degrees +/-1.64(p; 0.320) in last follow up lateral view. No breakage of intramedullary nails and no stiffness on adjacent joints.
CONCLUSION
We confirmed that unreamed interlocking nailing in tibial fractures is one of the effective method for low recurrence of malunion and early ambulation

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The Treatment Of Humeral Shaft Fracture With Rertograde Ao Unreamed Humeral Nail: Tae Woo Park, Sung Do Cho, Young Sun Cho, Bum Soo Kim, Sogu Lew, Moon Chan Kim, Ki Young Kim; J Korean Soc Fract 2002;15(3):398-403. Published online July 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.3.398

Abstract PDF: PURPOSE
To evaluate the results of the treatment of humeral shaft fractures using retrograde AO Unreamed Humeral Nail(UHN).
MATERIALS AND METHOD
From Apr. 1998 and Aug. 2001, 18 humeral shaft fractures were treated with retrograde AO UHN. All fractures were classified according to the AO classification. The results were analyzed by bony union time, range of motion and complication.
RESULTS
There were eleven cases of A3, two B2, one B3, four A2 humeral middle shaft fractures according to the AO classification. The mean bony union time was 12.2 weeks(range;9-16 weeks). All patients regained full range of motion of the shoulder joint and the elbow joint but 2 patients with intraopenatively ruptured capsule had transient elbow motion limitation. Complications were iatrogenic fractures at the entry portal in 2 patients(15%), transient shoulder pain in 4 patients(30.7%), nonunion in 1 patient(7.6%), required bone graft and internal fixation after removal of the nail at 13 months postoperatively.
CONCLUSION
The treatment of humeral shaft fracture with retrograde AO unreamed humeral nail is one of the good options to reduce the rate of non-union or delayed union by compression effect if the intraoperative errors is prevented.

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Comparison of External Fixation and Interlocking IM Nail in Open Tibial Fractures: Hyung Jin Chung, Duck Kyu Kim, Yerl Bo Sung, Jong Guk Ahn; J Korean Soc Fract 2001;14(4):632-642. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.632

Abstract PDF: PURPOSE
To compare and analyze the results of the treatment based on the method of treatment between interlocking IM nail and external fixation of type II, III A, and III B open fractures of the tibia] shaft.
MATERIALS AND METHODS
A clinical analysis was performed on 57 cases of type II, III A, and III B open fractures of tibial shaft from January 1994 to October 1999 those studies are followed at least 1 year or more. The results was analyzed according to complications and functional results based on operative methods of types of open fractures.
RESULTS
In aspect of delayed union and nonunion, interlocking IM nail indicate a great results(p = 0.036) in type II. In angulation, interlocking IM nail marks an outstanding results in case of type II. There is no difference between interlocking IM nail and external fixation in infection. But, the delay of operation after injury increase the possibilities of infection.
CONCLUSION
At present, especially in type m, external fixation was preferred. But, interlocking IM nail has a good results in aspect of complications. Therefore unreamed intramedullary nailing for open tibia shaft fractures is a good treatment method to be recommended.

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Comparison of the results between reamed and unreamed femoral nailing: Bum Soo Kim, Sung Do Cho, Yong Sun Cho, Tae Woo Park, Sogu Lew, Hyung Jin Cho, Soo Hyun Cho; J Korean Soc Fract 2001;14(2):208-213. Published online April 30, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.2.208

Abstract PDF: PURPOSE
To evaluate the effectiveness between reamed and unreamed nailing in the treatment of femoral shaft fracture.
MATERIALS AND METHODS
Among the patients of femoral shaft fracture who were treated with reamed and unreamed nail, we reviewed 49 patients whose follow-up was possible for more than 1 year. The patients were divided into two groups: the reamed and the unreamed group. We reviewed union time, nonunion rate, complication and operation time and compared the effectiveness.
RESULTS
The average union time was 30.6 weeks in unreamed group and 27.8 weeks in reamed group, which was not different statistically. There were 5 cases of nonunion in 22 unreamed cases and 3 cases in 27 reamed cases, which meant no statistical difference. There was no significant difference of complications between the two groups. The mean operation time was 141 minutes in reamed group and 110 minutes in unreamed group, which meant statistical difference.
CONCLUSION
There was no significant difference in union time, nonunion rate and comlication between reamed and unremed group. The operation time was shorter in unreamed group, so unreamed nailing can be preferred in the treatment of multiply injured patient.

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Treatment of the Femoral Shaft FracturesUsing Unreamed Interlocking Intramedullary Nail: Chang Wook Oh, Joo Chul Ihn, Poong Taek Kim, Shin Yoon Kim, Hee Soo Kyung, Chung Hyun Lee; J Korean Soc Fract 2000;13(4):832-836. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.832

Abstract PDF: PURPOSE
To evaluate the usefulness of unreamed nailing inthe treatment of femoral shaft fractures.
MATERIALS AND METHODS
Between March 1996 and June 1998, unreamed nailing with closed method was done for 74 patients with 82 femoral shaft fractures. The main indications for this treatment were multiple injury or isolated femoral fracture above Winquist type II. The influence of Winquist- Hansen classification, anatomical location, and open injury over bone union and the influence of injury severity score over general complication including fat embolism were investigated.
RESULTS
Primary union occurred in 76 cases(93%) with 6 cases of nonunion and 10(12%) of delayed union, and mean time to union was 27 weeks. In open fractures, the union time was delayed(32 weeks) rather than closed fracture. In Winquist classification, there was no stastical importance on time to union, but nonunion was most common in Winquist type IV. Anatomical location has no influence on time to union. In the view point of multiple injury, the group above 18 points(31 patients) in injury severity score had none of fat embolism, but the group below 18 points(43 patients) had 2 patients.
CONCLUSION
The treatment of femoral shaft fractures by unreamed nailing had longer time to union with higher rate of delayed union, and we think that the theoretical advantage of decreasing pulmonary complications is controversial.

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Intramedullary pressure changes in reamed and unreamed nailing systems: an experimental study in cadaveric femoral bones: Chang Wug Oh, Joo Chul Ihn, Poong Taek Kim, Il Hyung Park, Sung Jung Kim, Chung Hyun Lee; J Korean Soc Fract 2000;13(3):631-637. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.631

Abstract PDF: PURPOSE
This study was designed to investigate whether intramedullary pressure is different in reamed compared with unreamed femoral nailing in cadeveric femoral bones. MATERIALS & METHODS: Eight pairs of fresh-frozen cadaveric femoral bones were studied. The diameter of isthmus was checked from 10mm to 14mm and the length of femur was checked from 35cm to 44cm. Intramedullary pressure was measured in the distal femoral shaft at the supracondylar region. Data were monitored in femoral nailing procedures. We utilized the AO universal nail(reamed) and AO unreamed femoral nail.
RESULTS
Intramedullary pressure increased in the reamed group to 423.8 mmHg(mean pressure) during reaming by starting reamer(9 mm) and in the unreamed group to 290 mmHg(mean pressure) during insertion of nails(p=0.001). In the unreamed groups, the next high intramedullary pressure is 136.6 mmHg during proximal reaming. A statistiscally significant difference in intramedullary pressure was found during the first reaming process in the reamed group compared with the proximal reaming process in the unreamed group(p=0.005).
CONCLUSION
The data indicate that the intramedullary pressure during unreamed nailing process is lower than reamed nailing process. So we can consider that the unreamed nailing in multiple fracture or pulmonary injured patients is a good modalities.

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A Comparison of Reamed and Unreamed Interlocking Intramedullary Nailing for Closed Fractures of the Tibia Shaft: Keun Bae Lee, Sung Taek Jung, Dae Chang Joo, Jae Joon Lee; J Korean Soc Fract 2000;13(3):515-521. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.515

Abstract PDF

PURPOSE
To get a reliable clinical data of interlocking IM nailing, the authors compared the results of the reamed interlocking IM nailing(Reamed) with unreamed interlocking IM nailing(Unreamed) in only closed fractures of tibial shaft. MATERIAL AND METHODS: Each Reamed(n=40) and Unreamed group(n=31) was followed by twenty-nine(13-53) months and twenty-one(13-55) months. We analyzed the results and complications of the each group.
RESULTS
The average total duration of the procedures performed without reaming was 13 minutes shorter than that of the procedures done with reaming(p>0.05). Twenty-nine fractures(73%) that were treated with reaming and eighteen(58.1%) that were treated without reaming united at postoperative 4 months. But, thirty-eight(95%) and twenty-nine(93.5%) fractures united at postoperative 6 months respectively. There was only one nonunion, which developed without reaming. Delayed union occurred after two nailing procedures with reaming and after one without reaming. Malunion occurred after one nailing with reaming and after two without reaming. There were two superficial infection, which developed after nailing with reaming.
CONCLUSION
There was no significant differences in the clinical and radiological result between reamed and unreamed nailing for the treatment of closed tibial shaft fracture. But, the bone union rate was significantly higher in reamed group than unreamed group at postoperative 4 months.

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Anterior Knee Pain after Intramedullary Nailing for Tibial Shaft Fractures
Suk-Kyu Choo, Hyoung-Keun Oh, Hyun-Woo Choi, Jae-Gwang Song
Journal of the Korean Fracture Society.2011; 24(1): 28. CrossRef

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Treatment Using Unreamed Intramedullary Nailing for Open Tibial Fractures: Chang Wug Oh, Hee Soo Kyung, Joo Chul Ihn, Byung Chul Park, Hyung Jin Park; J Korean Soc Fract 2000;13(2):281-288. Published online April 30, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.2.281

Abstract PDF: PURPOSE
: this paper was to evaluate the treatment results in the viewpoint of bone union, union time, and complications including infection of unreamed nailing of pen tibial fractures.
MATERIALS AND METHODS
: We reviewed 46 open tibial shaft fractures that were treated with unreamed tibial nail. AO unreamed tibial nail was inserted after reduction under image intensifier control, Considering factors were severity of open wound, type and location of fractures.
RESULTS
: Average union time of open fractures was 21.3 weeks, nonunion rate was 2/46(4%). Average union tiome were 24.1, 19.7, 24, 24, 20 weeks in open grade I , II, IIIa, IIIb, IIIc fractures. According to the type of fractures, average union time were 20.4, 23.6, 25.7 weeks and nonunion rate were 0/22, 1/18, 1/6 in type A, B, C fractures. According to the level of fractures, average union time were 24.0, 20.0, 24.1 weeks in proximal, middle, and distal fractures. There was no signficant differences in average period of radiologic union, infection rate and nonunion rate according to fracture level, open grade, but longer union time and higher nonunion rate were observed in complex and comminuted fractures(p<0.05).
CONCLUSION
: With adequate soft tissue treatment, the unreamed intramedullary nailing can be a good treatment modality for open tibial shaft fractures, even to grade IIIB.

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Treatment of the Open Tibial Fractures with Unreamed AO Intramedullary Nail: Bum Soo Kim, Sung Do Cho, Yong Sun Cho, Soon Woo Hong, Hyung Jin Cho, Ki Yong Kim; J Korean Soc Fract 2000;13(1):81-86. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.81

Abstract PDF: PURPOSE
To evaluate the results of open tibial fractures treated with unreamed AO intramedullary nail MATERIALS AND METHODS: Among the patiens of open tibial fractures who were treated with unreamed AO intramedullary nail from January 1993 to August 1998, the authors reviewed 34 patients whose follow-up was possible for more than one year. Fourteen patients were treated with AO external fixator after meticulous debridement, followed by unreamed AO intramedullary nailing, and the other 20 patients were treated with primary unreamed AO intramedullary nailing after debridement. The authors evaluated the results by the union time and the presence of complication.
RESULTS
The average union time was 26.3 weeks. There was no significant difference of union time and complications between the patients who were treated with AO exteranl fixator followed by unreamed AO intramedullary nailing and the patients who were treated primarily with debridement and unreamed AO intramedullary nailing. However there was high incidence(21%) of interlocking screw breakage.
CONCLUSION
With meticulous debridement and close observation of the wound, the open tibial fractures can be effectively treated with unreamed AO intramedullay nailing. Unreamed intramedullary nailing of open tibial fractures immediately after trauma can be recommended in selected cases.

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Treatment of the Femoral Shaft Fractures Using Reamed Russell-Taylor Intramedullary Nail: Shin Yoon Kim, Jun Dae Kwun, Hak Su Kim, Byung Gook Kim, Chang Wug Oh, Byung Chul Park, Joo Chul Ihn; J Korean Soc Fract 1999;12(4):824-832. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.824

Abstract PDF: The purpose of this paper was to evaluate the results of the femoral shaft fractures by reamed Russell-Taylor intramedullary nailing in the viewpoint of union time and complications. We reviewed 59 femoral shaft fractures. According to the type of fractures(Winquist-Hansen classification), average union time were 20.1 and 23.5 weeks in type 1, 2 and 3, 4, and nonunion rates were 12.5% and 10.5% in type 1, 2 and 3, 4. According to the level of fractures, average union time were 19.9, 20.3, 23.4 weeks in proximal, middle and distal fractures, and nonunion rates were 6.7%, 8.8%, 30% in proximal, middle and distal fractures. According to the reduction techniques, average union time were 20.0 and 21.5 weeks in closed and open reduction, and nonunion rates were 5.9% and 20.O% in closed and open reduction. According to the Methods of interlocking screw fixation, average union time were 19.3 and 20.7 weeks in dynamic and static fixation, and nonunion rates were 25% and 9.8% in dynamic and static fixation. There was no significant differences in averdge union time between closed and open fracture group, closed and open reduction group, and dynamic and static fixation group. There was significant differences in union time between simple and complex, comminuted fractures(P<0.05), and between distal and proximal, middle fractures(P<0.05). Also there was significant differences in nonunion rate between fracture reduced with closed and open technique(P<0.05). In conclusion, reamed Rustell-Taylor intramedullary nailing can be a uheful treatment modality in femoral shaft fracture if closed reduction is available. However, there was high complication rate including failure of screw, varut deformity, delayed union time in distal femoral shaft fractures. In this situation, we should consider other treatment method.

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Treatment of open Tibial Shaft Fractures with Unreamed Interlocking Intramedullary Nailing: Jeung Tak Suh, Byung Guk Park, Chong Il Yoo; J Korean Soc Fract 1999;12(3):568-576. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.568

Abstract PDF: Severe open fracture of the tibia have a high incidence of complications and a poor outcome. The most usual method of stabilization was by external fixation, but the advent of small diameter interlocking intramedullary nails has introduced a new option. From the June 1992 to December 1997, 55 cases of open tibial shaft fracture were treated with unreamed interlocking intramedullary nailing at the department of orthopedic surgery, Pusan National University Hospital. The purpose of this study is to evaluate its result and complications. Mean age was 31, mostly male. The main cause of trauma was traffic accidents(30 cases, 55%) and fracture sites consisted of mid 1/3 portion over 75%. According to the Gustilo & Anderson classification 8 type I(15%), 22 type II(40%), 15 type IIIA(27%) and 10 type IIIB(18%) were shown. Union time was 28.3 weeks on an average and union rate was 98%. There were 5 cases(9%) of delayed union, 2 cases(4%) of deep infection and 1 case(2%) of chronic osteomyelitis. In conclusion unreamed interlocking intramedullary nailing can be the first choice treatment in the treatment of open tibia shaft fractures with low postoperative infection.

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Treatment of Humeral Shaft Fracture with AO Unreamed Humeral Nail: In Heon Park, Kee Byoung Lee, Kyung won song, Jin Young Lee, Min Choi; J Korean Soc Fract 1999;12(2):429-434. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.429

Abstract PDF: We performed a retrospective study of nine humeral shaft fractures which were treated by interlocking intramedullary nailing, the AO UHN (Unreamed Humeral Nail) system between March 1996 and February 1997 with more than one year of follow up. AO UHN inserted by either antegrade or retrograde technics through limited incisions followed by insertion of 2 proximal and distal Interlocking screws. Compression between fractured fragments was achieved in the non-comminuted and indicated cases. Immediate postoperately, soft shoulder immobilizer was applied and rehabilitation was started with active shoulder motion exercise few days to 1 week postoperately as soon as patient could tolerate pain. Union occurred at average of 13 weeks except one expired case with pathologic fracture due to advanced metastatic cancer. Pain relief and functional restoration were rated as good to excellent in most cases. Interlocking intramedullary nailing using AO UHN for the humeral shaft fractures usually provides immediate stability of the fracture and can be accomplished with a closed technique, minimum morbidity, with a resultant early return of function of the extremity. Therefore we recommend AO UHN for the treatment of the humeral shaft fractures if available without hesitation.

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Reamed versus Unreamed Intramedullary Nailing after External Fixator Application in the Treatment of Open Tibial-Shaft Fracture: Dong Bae Shin, Joon Cheol Choi, Young Soo Lee, Yong Jeng Kim, Soo Hong Han, Dong Eun Shin, Yeun Ho Lee; J Korean Soc Fract 1999;12(2):272-276. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.272

Abstract PDF: The authers reviewed 15 patients of open fracture of the tibial shaft who were treated by external fixation followed by intramedullary nailing. These fractures comprised two Type-I, two Type-II, four Type-IIIa, and seven Type-IIIb injuries. Ten patients were treated with unreamed intramedullary nailing and 5 patients were treated with reamed intramedullary nailing. The results were analyzed as followings: 1. All fractures had union at 5.2 months after intramedullary nailing and 4 true osteomyelitis were developed. 2. All osteomyelitis were developed for the patients who were treated with reamed intramedullary nailing. 3. There was no osteomyelitis who were treated with unreamed intramedullary nailing. 4. Delayed conversion to intramedullary nailing after control of pin tract infection had no effect for prevention of osteomyelitis.

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Use of Interlocking Intramedullary Nail in Treatment of Delayed Union or Nonunion of the Long Bone Fractures: Suk Kyu Choo, Byung Jik Kim, Han Suk Ko, Jeong Gook Seo, Jin Gu Kim, Jun Woo Chang; J Korean Soc Fract 1998;11(4):761-768. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.761

Abstract PDF

Of the several nonoperative and operative options described for the treatment of delayed union and nonunion of the long bone, interlocking nailing with reaming offect of internal splint, autogenous bone graft and early return to a normal way of life. The purpose of this study is to evaluate the usefulness and complication of intramedullary(IM) naling with reaming by retrospective method. We treated 34 patients with delayed union or nonunion of the tibia, femur, and humerus by interlocking nailing with reaming between January 1992 and December 1996. The results were as follows ; 1. Of the 34 cases, there were 13 tibia fracture, 17 femur fracture, 4 humerus fracture. Half of them were ununited and another half were delayed in fracture healing. 2. Previous methods of treatment were conservative treatment in 2 cases, external fixator in 2, plate & screws fixation in 8, Ender nail in 2, Kuntscher nail in 2 and interlocking nail in 7 among 24 cases of cloed fracture and external fixator in 8 and interlocking nail in 2 among 10 cases of open fracture. 3. Twenty-five patients were treated with closed nailing and 9 were treated with open nailing. Iliac bone graft was performed at 3 cases and fibulotomy was performed at 1 case. 4. Union was obtained in 33 cases and 1 case needed additional bone grafting to achieve union. 5. Postoperative complications were one nonunion, two evtry site pain, one screw breakage, one heterotopic ossification, and one postoperative infection. Interlocking nailing with reaming was associated with a high union rate(97%) in our eries. The authors believe that IM nailing with reaming is a useful option for treatment of delayed or nonunion of the long bone fracture.

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Cause and Treatment of the Nonunion of Femoral Shaft Fracture after Interlocking Intramedullary Nailing
Sung-Soo Kim, Sung-Keun Sohn, Chul-Hong Kim, Myung-Jin Lee, Lih Wang
Journal of the Korean Fracture Society.2007; 20(2): 141. CrossRef

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A Clinical Comparative Study of Reamed and Unreamed Nail of Femoral Shaft Fracture: Hyung ku Yoon, Kwang Pyo Jeon, Kyung Hun Kang, Jin Il Kim, Dong Soo Kim, Young Kwan Koh; J Korean Soc Fract 1998;11(3):495-500. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.495

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The purpose of this study is to verify the clinical efficacy of unreamed nails compared to reamed nails. The cases of 31 parients in whom 32 fractures of the femoral shaft had been treated by intramedullary nailing with reamed or unreamed nails were prospectively reviewed. Reamed nailing was done for 17 cases, and unreamed nailing was done for 15 cases. The following results were obtained. 1. According to Winquist-Hansen classification, type 1 was 9 cases, type 2,3,4 were 4,2,2 cases 2. The average operation time was 70.5 minutes in reamed group, and 62.5 minutes in unreamed group(p-value=0.638). the average bleeding amount was 450ml in reamed group, and 218ml in unreamed group(p-value=0.000). 3. The mean times to partial weight bearing and full weight bearing were 4.4 weeks, 7.7 weeks in reamed group retrospectively, and 7.2 weeks, 13.7 weeks in unreamed group(p-walue=0.039,0.002). 4. The mean union time was 15.2 weeks in reamed group, and 17.7 weeks in unreamed group(p-value=0.237). 5. According to Denker's functional classification, 15 cases were excellent, 1 case was satisfactory, 1 case was very poor in reamed group, and 13 cases were wxcellent, 1 case was satisfactory, 1 case was poor in unreamed group(p-value=0.545).

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Bursting Fracture of the Proximal Femur during Insertion of Unreamed Femoral Nail for Femur Shaft Fracture - A Case Report -
Ji Wan Kim, Seong-Eun Byun, Won-Hyuk Oh, Jung Jae Kim
Journal of the Korean Fracture Society.2010; 23(2): 227. CrossRef

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Treatment of the Femoral Shaft Fractures using Unreamed Interlocking Intramedullary Nail: Sung Taek Jung, Eun Sun Moon, Moon Lee; J Korean Soc Fract 1998;11(2):471-476. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.471

Abstract PDF: The current trend in the use of the unreamed intramedullary nail to avoid the increased damage to the intramedullary blood supply may be theoretically attractive for femoral shaft fracture stabilization but little clinical and radiological attention was reported. We have evaluated the results of treatment of femoral shaft fracture with unreamed interlocking intramedullary nail. Thirty-eight femoral fractures have been followed for more than twelve months were included in this study. Most of the fractures were the result of moderate to high-energy trauma. Thirty-three cases were fresh closed fracture and five were open fractures. Winquist-Hansen type I fracture (16 cases) were most common and healing period was shorter than other type. Healing occurred in 35 cases and mean healing period was 18.7 weeks with a range of 11 to 32 weeks. Postoperative complications were delayed union in 3 cases. We concluded that unreamed interlocking nailing for femoral shaft fracture seems to be a useful method with low complication rate.

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Clinical Results of Unreamed Static Interlocking Intramedullary Nailing In Clsed Tibial Shaft Fractures: Sang Yeon Lee, Young Shik Shin, Jeong Ho Yang, Heun Young Park; J Korean Soc Fract 1998;11(2):449-455. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.449

Abstract PDF: For the treatment of tibial shaft fracures interlocking intramedullary nailing has been used widely. Recently choosing between reamed or unreamed interlocking nailing for closed tibial shaft fracture is still controversial. The purpose of this study is to evaluate the results and complications of unreamed interlocking nailing for closed tibial shaft fractures. We reviewed 28 closed tibial shaft fractures that were treated with unreamed static medullary nailing from May 1993 to December 1996 at the Deparment of Orthopaedic surgery, Pohang St. Mary's Hospital. The results were as follows 1. In all 28 cases, union of the fracture was achieved at average 19.6 weeks and tere was no malunion. 2. We performed additional procedures in 4 cases(14.3%) for union : autogenous iliac bone graft in 1 case(3.5%) that was unstable segmental fracture and dynamization in 3 cases(10.7%) 3. There was breakage of distal locking screw in 1 case but no breakage of intramedullary nail.

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Interlocking Intramedullary Nailing in the Treatment of the Tibial Shaft Fractures: Comparative Study between Reamed and Unreamed Nailing: Jae Hoon Lee, Kyung Jin Song, Byung Yun Hwang; J Korean Soc Fract 1996;9(4):993-1001. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.993

Abstract PDF: Interlocking intramedullary nailing has been popularized by its many advantages in the fracture treatment of long bone compared with the other fixatives. The purpose of this paper was to evaluate the treatment results in the viewpoint of bone union, complication and functional outcomes of the interlocking intramedullary nailing between reamed and unlearned technique in the treatment of tibial shaft fractures. We reviewed 64 tibial shaft fracture that were treated at our hospital from May 1990 to February 1995 with interlorking intramedullary nailing that composed 36 reamed, and 28 unlearned cases. These included 33 open fractures and 34 closed fractures. There was no significant di florences in average prriod of radiologic union, complications and in the functional outcomes between the two treatment grovps(P<0.05). Unlearned interlocking intramedullary nailing in the tibial shaft fractures must be a goof treatment modality by its simplicity, shorter operation time, less probability in pulmonary and throrrlboembolic complications and less comprormised medullary blood supply, especially in patients with multiple trauma or open fractures.

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Treatment with Unleamed Interlocking Intramedullary Nail for Tibial Shaft Fracture: Hyung Ku Yoon, Kwang Pyo Jeon, Dae Eun Jung, Ho Seung Jeon, Man Je Park; J Korean Soc Fract 1996;9(2):466-474. Published online April 30, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.2.466

Abstract PDF: Recently intramedullary nailing has become the most common method treating tibial fractures. Reamed intramedullaiy nailing technique leaves the problem of destorying the endosteal blood supply, which associated with delayed union and postoperative infection. Recent reports have shown excellent rate of union and low rate of intection with unlearned interlocking intramedullary nail. Author reviewed 58 cases of tibia shaft fractures that were treated with unrealned interlocking nail from Feb. 1992 to Feb. 1994. 1. Furty nine fractures were closed and 9 were open (Gustilo-Andersonl;3,II;5, IIIa;1). Thrity one fractures involved the distal portion, 19 fractures the middle portion, 6 fractures tile proximal portion and 2 fractures were segmental. 2. Thirty six cases were male and 22 were female. The most common age was 3rd decade (25.8%). 3. The most common caute was traffic accident. 4. Average interval from injury to operation were 5.7 days in close fracture and 11.3 days in open fracture. 5. The mean duration of bone union were 15.7 weeks in closed fracture and 19.5 wreks in open fracture. 6. Complications include 1 case of delayed union, 1 case of joint stiffness and 1 case of screw failure. 7. According to the functional results by Klemm and Borner, 42 cases were excellent, 15 cases were good and 1 was fair.

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Treatment of Open Fracture of Tibial Shaft with Non-reamed Interlocking Nailing: Byung Woo Min, Kwang Soon Song, Chearl Hyung Kang, Ki Weon Park; J Korean Soc Fract 1995;8(4):841-847. Published online October 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.4.841

Abstract PDF: Intramedullary nailing for the treatment of a fractured tibia has proven its value not only through rigid fixation but also early joint motion and weight bearing which promote more rapid bony union and functional recovery. Recently reaming intramedullary nailing technique leaves the problems of destroying the endosteal blood supply, which associated with delayed union and postoperative infection. The purpose of this study is to evaluate the results and the complications of nonreamed interlocking intramedullary nailing in the treatment of open tibial fractures. The authors reviewed 20 cases of open fractures of tibial shaft that were treated with nonreamed interlocking intramedullary nailing from May 1993 to July 1994 The follow up period ranged from 12 to 26 months. The results were summariBed as follows. 1. The average period of radiologic union was obtatined in 21.2 weeks. 2. Complications include 1 case of delayed union and 1 case of postoperative infection in Type III open tibial fracture. Locking screw broke in 1 case of Type I open tibial fracture. 3. According to the criteria of functional results by Klemm and Borner, 18 cases(90%) showed excellent results.

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Comparison of Reamed and Unlearned type Intramedullary Interlocking Nail in Treatment of Tibia Shaft Fracture: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Kim, Soo Gon Kim; J Korean Soc Fract 1995;8(3):572-577. Published online July 31, 1995; DOI: https://doi.org/10.12671/jksf.1995.8.3.572

Abstract PDF: The authors analyzed 41 cases of fresh diaphyseal fracture of tibia who were treated with intramedullary interlocking nail between Oct. 1991 to Oct. 1993. in Hae-Dong hospital and followed up for 12 months or more. Among 41 cases, 18 cases were treated with reamed nailing method, and the others with unlearned method. The authors compared the results of 2 type of nailing method and obtained the following results. 1. Most of the cases(63%) had injury in their third and forth decade. Male was 31 cases. 2. The most common cause of injury was traffic accident(61%). 3. The mean bony union time was 16.5 weeks in reamed case, and 15.6 weeks in unlearned case. 4. The patients were judged to have good or excellent result in 89% of reamed cases and 87% of unlearned cases according to functional result by Klemm and Borner. The merits of unlearned intramedullary interlocking nail were relatively easier in procedure, short operation time, and less bleeding. So the authors concluded that unlearned intramedullary interlocking nail is useful method to treat the tibial diaphyseal fractures, especially in open fracture, elder patient and complicated patient.

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Treatment of the Fractures of the Humeral Shaft with the Non-reamed True/Flex Humerus Rod: Dong Chul Lee, Jae Sung Seo, Sang Don Kim; J Korean Soc Fract 1994;7(1):122-130. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.122

Abstract PDF: Recently, surgical intervention of the fractures of the humeral shaft was increased due to the severe trauma occuring in the traffic accident and industrial accident, even if closed treatment was appropriate in the humeral diaphysis. In order to obtain the early mobilization prevention of the nonunion and joint stiffness, rigid fixation of the fracture is needed. To reduce the complication of the open reduction (nonunion, infection, radlal neue palsy), closed intramedullary nail fixation techlnques without opening the fracture site were used. Eight cases of the fractures of the humeral shaft were treated with nonreamed True/Flex humerus rod system(intramedullary fixation) between Nov.1992 and Apr.1993. And the obtained results were as follows. 1. The normal healing cases were S and its average healing time Is post-op. 9.2 weeks. There were nonunion in 1 case and delayed union in 2 cases. 2. The causes of the injury were traffic accident in 6 cases fall down in 1 case, belt injury in 1 case. 3. The causes of the nonunion and delayed union were as follows distraction(by inappropriate selection of the rod and physical treatment) in 2 cases, insufficient immobilzation in 1 cases. 4. The True/Flex humerus rod seemed to recommand to the patients with multiple, open, segmental fractures and poor qeneral condition.

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