Reamer Breakage during Intramedullary Nailing in Tibial Shaft Fractures: A Case Report and Review of Literature

Background: Interlocked intramedullary nailing is the most common treatment for closed tibial fractures. Reaming is a fundamental step in this surgical technique, and reamer breakage is a rare yet challenging complication during this operation. Case Report: A 34-year old male with a tibial shaft fracture was admitted for early closed tibial nailing. During the reaming process, the reamer broke and stuck in the medulla at the isthmus level. We extracted the broken piece by back hammering a cannulated T-handle placed on the ball tip guide pin. Conclusion: In this closed and quick method, we did not use any extra device other than standard equipment of intramedullary nailing.

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Pseudoaneurysm of the Anterior Tibial Artery After Closed Intramedullary Nailing of a Tibial Shaft Fracture: A Case Report

The Journal of the Korean Orthopaedic Association ◽

10.4055/jkoa.2002.37.4.574 ◽

2002 ◽

Vol 37 (4) ◽

pp. 574 ◽

Cited By ~ 3

Author(s):

Kyeong Jin Han ◽

Ye Yeon Won ◽

Tae Young Kim ◽

Shin Young Khang

Keyword(s):

Case Report ◽

Intramedullary Nailing ◽

Shaft Fracture ◽

Anterior Tibial Artery ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Tibial Artery ◽

Anterior Tibial ◽

Closed Intramedullary Nailing

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Impact of centre volume, surgeon volume, surgeon experience and geographic location on reoperation after intramedullary nailing of tibial shaft fractures

Canadian Journal of Surgery ◽

10.1503/cjs.004020 ◽

2021 ◽

Vol 64 (4) ◽

pp. E371-E376

Author(s):

Marc Swiontkowski ◽

David Teague ◽

Sheila Sprague ◽

Sofia Bzovsky ◽

Diane Heels-Ansdell ◽

...

Keyword(s):

Clinical Trial ◽

Intramedullary Nailing ◽

Shaft Fracture ◽

Tibial Shaft Fracture ◽

Tibial Shaft ◽

Intramedullary Nails ◽

Shaft Fractures ◽

Fracture Management ◽

Low Volume ◽

Tibial Shaft Fractures

Background: Tibial shaft fractures are the most common long-bone injury, with a reported annual incidence of more than 75 000 in the United States. This study aimed to determine whether patients with tibial fractures managed with intramedullary nails experience a lower rate of reoperation if treated at higher-volume hospitals, or by higher-volume or more experienced surgeons. Methods: The Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) was a multicentre randomized clinical trial comparing reamed and nonreamed intramedullary nailing on rates of reoperation to promote fracture union, treat infection or preserve the limb in patients with open and closed fractures of the tibial shaft. Using data from SPRINT, we quantified centre and surgeon volumes into quintiles. We performed analyses adjusted for type of fracture (open v. closed), type of injury (isolated v. multitrauma), gender and age for the primary outcome of reoperation using multivariable logistic regression. Results: There were no significant differences in the odds of reoperation between high- and low-volume centres (p = 0.9). Overall, surgeon volume significantly affected the odds of reoperation (p = 0.03). The odds of reoperation among patients treated by moderate-volume surgeons were 50% less than those among patients treated by verylow-volume surgeons (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.28–0.88), and the odds of reoperation among patients treated by high-volume surgeons were 47% less than those among patients treated by very-low-volume surgeons (OR 0.53, 95% CI 0.30–0.93). Conclusion: There appears to be no significant additional patient benefit in treatment by a higher-volume centre for intramedullary fixation of tibial shaft fractures. Additional research on the effects of surgical and clinical site volume in tibial shaft fracture management is needed to confirm this finding. The odds of reoperation were higher in patients treated by very-low-volume surgeons; this finding may be used to optimize the results of tibial shaft fracture management. Clinical trial registration: ClinicalTrials.gov, NCT00038129

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