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Reamed vs. Unreamed Intramedullary Nailing of Femoral Fractures in the Elderly

Introduction: Intramedullary nailing (IMN) is an established and accepted procedure for the treatment of femoral shaft fracture in patients younger than 65; however, there are few studies regarding the efficacy of IMN on those over 65. Elderly patients have particular challenges, including osteopenia and other medical problems and comorbidities. Therefore, the purpose of this study was to compare reamed versus unreamed IMN, and to determine which of these method yields better results in the elderly.

Patients and methods: Between March 2000 and February 2016, we treated 822 femoral shaft fractures, 384 of which underwent IMN. Of these patients, 88 were older than 65, and 72 of these fulfilled our inclusion criteria. Seven patients died within the first 3 months after the injury. The charts of the surviving 65 patients (48 (73.8%) female and 17 (26.2%) male, each with one femoral shaft fracture) were reviewed retrospectively. The average age of the included patients was 73.72 years (65-90), and the average follow up period was 86.3 months (12-183).

Results: Of the 65 fractures, 13 (20%) were proximal shaft, 48 (73.8%) were mid-shaft, and 4 (6.2%) were distal shaft. Two (3.1%) of the fractures were open (Gustilo grade 1), the rest were closed. Of the fractures, 29 (44.6%) were treated with reamed IMN, and 36 (55.4%) were treated with unreamed IMN. Non-union was seen in five patients (7.7%). Four patients in the unreamed group and one patient in the reamed group needed a secondary procedure (p=0.028); the nails were changed, and all achieved union. The fractures in the URFN cases took longer to heal (mean 37.76 weeks) than those in the RFN group (27.09 weeks, p=0.022). There were two (3.27%) distal screw breakages in the unreamed group.

Conclusion: We recommend using reamed IMN to achieve quicker union and to have better union rates.


Enes Ocalan, Cihad Cagri Ustun and Kemal Aktuglu

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