The Canadian Orthopaedic Trauma Society (2006)
Reamed versus unreamed intramedullary nailing of the femur: comparison of the rate of ARDS in multiple injured patients.

Author summary

Three hundred and fifteen patients with 322 femoral shaft fractures were divided into two groups based on their estimated injury severity score (ISS; < 18 versus. ≥ 18) and then randomized to receive either reamed or unreamed intramedullary nailing within 24 hours following the trauma. Among the 168 patients that received a reamed nail, 105 had an ISS < 18 and 63 and an ISS ≥ 18. Corresponding numbers for the 147 patients that received unreamed nails were 101 and 46, respectively. The overall incidences of acute respiratory distress syndrome (ARDS) and mortality were low, 1.6% and 1.3%, respectively. No statistically significant difference in the development ARDS or mortality was seen between the two groups. Therefore, the Canadian orthopedic trauma society believes there is no clinical data to support a change in the current practice of primary stabilization of femoral fractures with reamed intramedullary nails.