Author summary
Three hundred and fifteen patients with 322 femoral shaft fractures were divided into two groups based on their estimated injury severity score (ISS; < 18 versus. ≥ 18) and then randomized to receive either reamed or unreamed intramedullary nailing within 24 hours following the trauma. Among the 168 patients that received a reamed nail, 105 had an ISS < 18 and 63 and an ISS ≥ 18. Corresponding numbers for the 147 patients that received unreamed nails were 101 and 46, respectively. The overall incidences of acute respiratory distress syndrome (ARDS) and mortality were low, 1.6% and 1.3%, respectively. No statistically significant difference in the development ARDS or mortality was seen between the two groups. Therefore, the Canadian orthopedic trauma society believes there is no clinical data to support a change in the current practice of primary stabilization of femoral fractures with reamed intramedullary nails.
