JBJS -- Letters to the Editor for The Canadian Orthopaedic Trauma Society, 85 (11) 2093-2096

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Letters to the Editor to:

Scientific Articles:
The Canadian Orthopaedic Trauma Society
Nonunion Following Intramedullary Nailing of the Femur with and without Reaming. Results of a Multicenter Randomized Clinical Trial
J Bone Joint Surg Am 2003; 85: 2093-2096 [Abstract] [Full text] [PDF]

Letters to the Editor: Submit a response to this article

Electronic letters published:

Reamed V/S Unreamed nail in Femoral fractures: Singh Navdeep, Jiwan L Bassi, M Yamin, and Harpal S Selhi (6 July 2004)

Nonunion Following Intramedullary Nailing of the Femur: Richard Stern, M.D. (1 December 2003)

Reamed V/S Unreamed nail in Femoral fractures 6 July 2004

Singh Navdeep,
PG Registrar
DMC & Hospital, Ludhiana,
Jiwan L Bassi, M Yamin, and Harpal S Selhi
Send letter to journal:
Re: Reamed V/S Unreamed nail in Femoral fractures

selhi{at}satyam.net.in Singh Navdeep, et al.

To the Editor:
We read the article, "Nonunion Following Intra-medullary Nailing of the Femur With and Without Reaming" with interest and found it to be well planned and executed. However, we would like to point out an error in the Discussion
The authors have compared their results with those of Clatworthy et al.(1), and state that Clatworthy et. al, used only 10mm diameter nails in their trial and that the trial was discontinued due to problems of fixation failure.
We have read the original article of Clatworthy et al (1) and do not find this statement to be factual. Clatworthy et al did state that they used a variety of nails and failure was noted in nails of different diameters. Furthermore, of the six implant failures they reported, three were in reamed and three were in unreamed procedures.
In our experience, unreamed nailing is a specialised procedure to be used in clinical circumstances where the aim is to shorten the operative time and stabilise the fracture with minimal intervention, especially in conditions where a patient is in a suboptimal medical state, e.g. polytrauma, pulmonary compromise, or cardiac compromise (2)
References
1. Clatworthy MG, Clark DI, Gray DH, Hardy AE. Reamed versus unreamed femoral nails. A randomised, prospective trial. J Bone Joint Surg Br. 1999 Jul;81(4):741-2.
Bassi, JL, Selhi HS. Reamed versus unreamed nails. J Bone Joint Surg Br. 1999 Jul; 81(4): 741-2.

Nonunion Following Intramedullary Nailing of the Femur 1 December 2003

Richard Stern, M.D.,
Physician
Hopital Cantonal Universitaire de Geneve
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Re: Nonunion Following Intramedullary Nailing of the Femur

richard.stern{at}hcuge.ch Richard Stern, M.D.

To the Editor:
In the recent article entitled "Nonunion Following Intramedullary Nailing of the Femur With and Without Reaming" (2003;85:2093-2096), the authors missed an opportunity to analyze an important variable that is associatied with the development of nonunion--the level of the fractures.
The authors correctly refer to the study of Tometta(1) which showed that the difference in healing time and nonunion between the reamed and nonreamed groups was most noticeable in those fractures of the distal third of the femur. This is very important information.
While the authors acknowledge that one of their study's limitations was that "the level of fracture was not fully documented," I had to re-read the manuscript to be sure this was a prospective study! It is entirely unclear to me how in a prospective study where the AO/OTA classification of the femoral shaft fracture was applied in almost each and every case, something as simple as the level of fracture could not be recorded.
References 1. Tornetta P III, Tiburzi D. Reamed versus nonreamed antegrade femoral nailing. J Orthop Trauma. 2000;14:15-9.