Comparison of the effect of reamed and unreamed locked intramedullary nailing on blood flow in the callus and strength of union following fracture of the sheep tibia.

This study was performed to compare the effects of reamed and unreamed locked intramedullary nailing on blood flow in the callus and early strength of union in a fractured sheep tibia model. After the creation of a standardized short spiral fracture by three-point bending with torsion, each tibia was stabilized by the insertion of a locked intramedullary nail. Ten animals were allocated randomly into two groups: one that had reaming prior to nail insertion and one that did not. Blood flow was measured in real time with use of laser Doppler flowmetry. Endosteal perfusion was determined at the fracture site before and after nail insertion. Perfusion of the callus was measured at three locations (proximal diaphysis, fracture site, and distal diaphysis) and at three time intervals (2, 6, and 12 week follow-up). All animals were killed 12 weeks postoperatively, and the tibiae were tested to failure in four-point bending. Nailing with reaming resulted in a larger decrease in overall endosteal perfusion than nailing without reaming (p < 0.015). The presence or absence of reaming did not affect blood flow within fracture callus. Perfusion of callus was greatest at 6 weeks of follow-up. Bending strength and stiffness were the same in both groups at 12 weeks. The study demonstrated that perfusion of callus and early strength of union are similar following intramedullary nailing with or without reaming.