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Reamed Femoral Nailing and the Systemic Inflammatory Response

Wolinsky, Philip M.D.

Techniques in Orthopaedics: March 2004 - Volume 19 - Issue 1 - p 25-29

Early stabilization of long fractures can prevent systemic complications, but definitive stabilization of the femoral shaft with reamed intramedullary nailing (RIMNF) could cause complications in certain subsets of patients. Initially, it was thought that patients with thoracic injuries were at risk for complications, but this has been shown to not be the case. Current thoughts revolve around avoiding RIMNF in patients who have an overstimulated immune system and/or who are underresuscitated. These patients could react better to initial stabilization with an external fixator with later conversion to a RIMNF, so-called damage control surgery.

From the Department of Orthopedic Surgery, University of California/Davis Medical Center, Sacramento, California.

Address correspondence and reprint requests to Philip Wolinsky, MD, Department of Orthopaedic Surgery, 4860 Y Street, Suite 3800, Sacramento, CA 95817. E-mail:

© 2004 Lippincott Williams & Wilkins, Inc.