Intramedullary nailing of open fractures offers stabilization advantages, with delayed closed reamed nailing best for femur fractures and acute nonreamed nailing comparable to external fixation for tibia.
Does intramedullary nailing improve outcomes in patients with open fractures compared to other stabilization methods?
Intramedullary nailing is a viable and sometimes advantageous option for stabilizing open fractures, particularly of the femur and tibia, when appropriate techniques and indications are used.
Intramedullary nailing of open fractures requires careful surgical judgment, consideration of alternative techniques, and the ability to use a number of different methods, including various designs with or without obligatory reaming. With good technique and well-selected indications, intramedullary nailing of open fractures may offer advantages not available through other types of fracture stabilization. Open fractures of the femur are best treated with delayed closed reamed nailing. Acute open nailing of the femur is justified to salvage life and limb in multiply injured patients. Acute nonreamed nailing of open fractures of the tibia has been shown to give results comparable to external skeletal fixation. The role for intramedullary nailing of open fractures of the upper extremity is limited.
Michael W. Chapman (Sat,) conducted a review in Open fractures. Intramedullary nailing was evaluated. Intramedullary nailing of open fractures offers stabilization advantages, with delayed closed reamed nailing best for femur fractures and acute nonreamed nailing comparable to external fixation for tibia.