Effect of Limited and Standard Reaming on Cortical Bone Blood Flow and Early Strength of Union Following Segmental Fracture

OBJECTIVE: To quantitatively determine the extent to which limited and standard intramedullary reaming disrupts cortical circulation and to evaluate the effect on the biomechanical properties of the united fracture. DESIGN: Midshaft tibial osteotomies to create a 2.5-centimeter segment of diaphyseal bone were performed in ten adult dogs. Before insertion of a locked intramedullary nail, the tibia was reamed to either 7.0 millimeters (n = 5) or 9.0 millimeters (n = 5). Blood flow was measured using laser Doppler flowmetry during the nailing procedure and at eleven weeks postnailing. Bending stiffness and load to failure were determined for each healed tibia. RESULTS: Tibial blood flow was reduced for the limited and the standard ream groups by 63 percent (p = 0.002) and 83 percent (p = 0.0008), respectively. After canal reaming, perfusion was reduced to a greater extent in the standard ream group (p = 0.009). At eleven weeks postnailing, tibial perfusion increased to the same levels in both groups (p = 0.43) and returned to base-line values. Bending stiffness and load to failure were reduced after limited reaming (p = 0.002, p = 0.003) and standard reaming (p = 0.01, p = 0.002) were performed. Stiffness and load to failure were reduced to the same extent in both groups (p = 0.12, p = 0.25). CONCLUSIONS: Both limited reaming and standard reaming negatively affect diaphyseal cortical circulation. Limited reaming spares cortical perfusion compared with standard reaming at the time of nail insertion. No long-term advantage for limited reaming was demonstrated. Limited reaming may be advantageous acutely for the stabilization of tibial fractures in which the circulation is already compromised.