Pulmonary damage after intramedullary femoral nailing in traumatized sheep--is there an effect from different nailing methods?
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 10(6) cpm to 3.387 +/- 1.34 x 10(6) cpm; group 2: 2.699 +/- 0.34 x 10(6) cpm to 2.460 +/- 0.187 x 10(6) cpm). Intramedullary 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).(ABSTRACT TRUNCATED AT 250 WORDS)
Pape
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HC
Department of Trauma Surgery, Hannover Medical School, Germany.
Dwenger
A
A
Regel
G
G
Schweitzer
G
G
Jonas
M
M
Remmers
D
D
Krumm
K
K
Neumann
C
C
Sturm
J A
JA
Tscherne
H
H
D000118:Acetylglucosaminidase / Q000097:blood; D000818:Animals; D001794:Blood Pressure; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods*; D006439:Hemodynamics; D008163:Luminescent Measurements; D008196:Lymph / Q000502:physiology; D009104:Multiple Trauma / Q000150:complications / Q000503:physiopathology*; D009504:Neutrophils / Q000502:physiology; D011651:Pulmonary Artery / Q000503:physiopathology; D011654:Pulmonary Edema / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D012756:Sheep; D012771:Shock, Hemorrhagic / Q000150:complications / Q000503:physiopathology; D014280:Triglycerides / Q000097:blood
D014280:Triglycerides; D000118:Acetylglucosaminidase