Complications Involved With Reaming in Intramedullary Nailing: Meta-Analysis Review of the Recent Literature

Intramedullary nailing (IMN) is used to treat long-bone fractures and can be accomplished with or without reaming. Reaming involves widening the intramedullary canal for the passage of a larger nail, allowing greater union rates. However, there is potential for complications such as blood loss, infection, heat-related injuries, and compartment syndrome. Advances in the reaming technique system allow the collection of reaming debris and potentially alter complication rates of reaming. The aim of this review was to compare the risks of the adverse effects of intramedullary reaming by reviewing literature that compares it with other methods of fixation. Advances in the use of intramedullary reaming (i.e. the RIA system) and their associated complications were also considered. A review of the current literature using the PubMed database initially yielded 682 articles. Implementation of exclusion criteria identified 28 articles. These were used based on their recency and relevance to the local effects and systemic effects of intramedullary reaming. A literature review of 6 primary articles included in this study revealed a mild increase in blood loss after reamed versus non-reamed IMN. Using this system, the incidents of compartment syndrome and heat-related injuries also decreased. However, data on infection rate and systemic inflammation are inconclusive as to how reaming alters these complications. Non-union rates in reamed IMN were non-superior compared to unreamed IMN or external fixation. Therefore, the RIA system has the potential to reduce some complications of reaming; however, further large-scale, randomized, control trials measuring the same parameters are required for certainty.