Background There has been recent debate surrounding the necessity of reaming the medullary canal prior to the insertion of intramedullary nails (IMN) for trochanteric fracture fixation. We aimed to use data from the INSITE trial to compare outcomes between patients managed with reamed vs. unreamed IMN. Methods The INSITE study followed ambulatory patients aged 18 years and older with trochanteric fractures for one-year post surgery. Our current analysis only included patients who were managed with an IMN device and had complete data concerning whether the medullary canal was reamed prior to nail insertion. Our outcomes included medical (organ failure, respiratory distress, stroke, deep vein thrombosis DVT gastrointestinal upset, pneumonia, myocardial infarction, sepsis, or urinary tract infection UTI and fracture-related adverse events (AE, femoral shaft fracture, implant failure, surgical site infection, nonunion, limb shortening, and pain). We used Chi-Square and Fisher exact tests to compare the unadjusted rates of these outcomes between groups, and logistic regression to examine the independent association between reaming and outcomes. Results A total of 409 patients were included in our analysis, 267 (65.3%) in the reamed group, and 142 (34.7%) in the unreamed group. Patients in the unreamed group had higher rates of comorbidities, unstable fractures, long nails (260-460mm, vs. short 170-200mm) and were more likely to weight-bear on postoperative day one. We observed a higher rate of medical AE in the unreamed group (14.1%) compared to the reamed group (7.9%). Similarly, the rate of fracture-related AEs was higher in the unreamed group (8.5% vs. 3.4%). The most common fracture-related AEs in the unreamed group included hardware failure (1.4%), surgical site infection (1.4%), and screw protrusion (2.1%). Patients in the unreamed group continued to show a higher odds of fracture-related AE following adjustment for nail length and relevant comorbidities (odds ratio OR 2.98 1.12–7.89). Alternatively, we found no significant association between reamed vs. unreamed IMN and medical AE OR 1.83 [0.92–3.66) following adjustment for relevant covariables. Conclusion These data suggest that reaming the medullary canal prior to nail insertion may be beneficial in managing patients with trochanteric fractures via IMN. However, further research with larger sample sizes is required to confirm these findings.
Nowak et al. (Thu,) studied this question.