Reamed versus nonreamed anterograde femoral nailing

Objective: To compare reamed femoral nailing with unreamed femoral nailing. Design: Prospective, randomized. Setting: Two Level One trauma centers. Patients: One hundred seventy patients with 172 femur fractures were randomized to an unreamed or reamed group. Main Outcome Measures: Data included demographics, Injury Severity Score (ISS), operative time, blood loss, blood and fluid requirements, technical complications, time to callus formation, time to union, and complications. Results: There was no statistical difference in operative time, transfusion requirements, or hypoxic episodes between the groups. Intraoperative blood loss was greater in the reamed group. The time to union was 80 +/- 35 days for the reamed group and 109 +/- 62 days for the unreamed group (p = 0.002). This difference was most dramatic in the distal femur, with union in the reamed group occurring in 80 days compared with 158 days in the unreamed group (p = 0.012). There were more technical complications and delayed unions in the unreamed group. Conclusions: There is no advantage to the routine use of nailing without reamed insertion. Fractures treated with reamed nails heal faster than those treated with unreamed nails, especially distal fractures.