Study of the Reaming Products during Intramedullary Nailing of Long Bones

Abstract

The purpose of our study is to record the composition and the viability of reaming products during intramedullary nailing of tibia or femur. We studied 21 fractures (13 tibia and 8 femur). The patients had a mean age of 27 years (19-67) and did not present any systemic disease. The operation was performed during the first 3 days from the injury and there was pre-operative X-ray check for measuring the medullary cavity. For 16 fractures we used reamers with diameter smaller or equal to the medullar cavity and for the other 5 for biomechanical reasons we used bigger reamers. We extracted the products in aseptic conditions in the operating room and after the proper elaboration they were analyzed histologically. The patients were followed up until the complete healing of the fractures. Our first observation was, that in the very small reamers, which did not “touch” the endosteum, there were non-viable bone cells. While with reamers equal to the intramedullary diameter there was viable bone mass 35-70 % more than the non-viable. When the reaming exceeded this border microscopic analysis showed pieces (1-1.5 mm) of bone mass with few viable elements in the center of them and more compressed dead cells in the perimeter. From the p. o. follow-up it was remarkable that the patients whose bone was reamed without exceeding the medullary cavity's diameter showed primary callus formation on X-rays after 4-5 weeks, but the others only after 5-7 weeks. In conclusion, although our sample is not quite big enough, we can say that there are signs that the reaming products are more viable when the reaming does not exceed the medullary cavity's diameter. This fact seems to have a positive influence over the callus formation process.

Key words

Intramedullary nailing - reaming products - fracture healing

References

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