Cortical perfusion and local fat occlusion after intramedullary nailing of the ovine tibia--comparison of different surgical procedures.

Abstract The aim of this study was to determine whether reamed or unreamed nailing is more harmful to local bone perfusion and increases fat occlusion of transcortical vessels. Methods After creating a standard fracture of the sheep tibia, reaming was performed in the first group using an experimental optimised reaming system (RE), in the second group with the conventional AO reamer (RC). Unreamed nailing was performed in the third group (UN). UHN 7.5 mm titanium was inserted in all three groups. Intramedullary pressure was measured intraoperatively. Quantitative histological analyses of the bone were performed postoperatively. Results The highest fat occlusion of transcortical vessels occurred in UN (5.7%), the lowest in RE (1.6%). The least harm to intracortical circulation was caused by RE with 28% perfused intracortical vessels compared to 17% (UN) and 18% (RC). Conclusion The experimental optimised reaming system reduces circulatory disturbance and local fat occlusion compared to the existing nailing procedures.