This study compares results of unreamed Schneider intramedullary nailings with reamed Küntscher intramedullary nailings. Eighty consecutive closed intramedullary roddings of femoral shaft fractures performed at Parkland Memorial Hospital, Dallas, were reviewed. In the first 40 cases, straight, narrow Schneider or Küntscher rods with an average diameter of 10 mm were inserted following closed reduction. No reaming maneuvers and no effort to attain rigid cortical contact with either fracture fragment were made. In the next 40 cases, the standard Küntscher technique with reaming and cortical impingement of the nail on both fragments was employed using Küntscher nails of an average diameter of 13 mm. All patients were followed to fracture union. Analysis of patient and fracture variables (such as anatomic location and degree of comminution) showed no significant differences in the two groups. While both groups demonstrated multiple minor complications, including slight shortening, mild angulation, and variable degrees of malrotation, major complications were significantly greater in the nonrigid rod group. They included one nonunion, three implant failures, and several cases with unacceptable shortening.
Medullary reaming allows the use of stronger rods, improves stable osteosynthesis by permitting cortical contact with the nail, minimizes postoperative shortening, and stimulates healing by depositing morselized bone reamings in the fracture of hematoma. The versatility of the closed technique is markedly enhanced by routine reaming.