PULMONARY DAMAGE AFTER INTRAMEDULLARY FEMORAL NAILING IN TRAUMATIZED SHEEP—IS THERE AN EFFECT FROM DIFFERENT NAILING METHODS?


    loading  Checking for direct PDF access through Ovid

Abstract

Stabilization of femoral shaft fractures is a controversial issue in the management of patients with multiple trauma. Intramedullary nailing usually is preferred primarily; in recent years, however, pulmonary complications (e.g., ARDS) have been reported that were attributed to the reaming procedure. To study the effects of different nailing methods in a model of severe trauma, hemorrhagic shock and lung contusion were created at day 1 in sheep prepared by the method described by Staub. After recuperation (day 3) the animals in the study group (group 1) underwent intramedullary nailing of a closed femur without prior reaming; group 2 was treated with reaming and nailing according to AO standards. The reaming procedure led to an acute increase of pulmonary arterial pressure only in group 2 (19.8 ± 2.1 to 31.0 ± 4.6 mm Hg). Pulmonary triglyceride levels increased at parallel time points from 18.27 ± 2.3 to 33.04 ± 7.37 mg/dL only in group 2. Stimulatory capacity of polymorphonuclear leukocytes (PMNL) increased in the study group and decreased in controls (group 1: 2.652 ± 0.23 x 106 cpm to 3.387 ± 1.34 x 106 cpm; group 2: 2.699 ± 0.34 x 106 cpm to 2.460 ± 0.187 x 106 cpm). Intramedutery nailing caused an increase of lung capillary permeability in both groups; in the study group less damage was seen (group 1:0.390 ± 0.0006 to 0.354 ± 0.011; group 2:0.391 ± 0.0004 to 0.336 ± 0.015; p < 0.05). Intramedullary nailing after severe shock and lung contusion causes lung damage as a result of PMNL activation and triglyceride embolism; these effects are significantly less if nailing is performed without prior reaming.

    loading  Loading Related Articles