Reaming is beneficial in trochanteric fracture patients managed with intramedullary nails: a secondary analysis of the insite trial
Abstract
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.
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.
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…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 409 participants or records.
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