The effects of reaming and intramedullary nailing on fracture healing.

Most closed fractures of the shaft of the femur and tibia can be treated successfully with internal fixation with medullary or interlocking nails. Unlike plate fixation, intramedullary nailing does not provide absolutely rigid fixation, so that some motion at the fracture site exists. The process of reaming causes circulatory disturbances in the inner two-thirds of the diaphyseal cortex. However, this does not impede the formation of external callus. The parts of bone that have sustained vascular damage by trauma or surgery are revascularized. Delay in the healing process due to disruption of the blood supply to fracture fragments is not known. The majority of patients are able to weight-bear a few days after surgery.