title: Femur fractures and lung complications: a prospective randomized study of reaming.
abstract: Reaming the intramedullary canal during fixation of femoral shaft fractures may contribute to pulmonary morbidity in patients with trauma. The purpose of our study was to compare acute and late pulmonary complications after reamed or nonreamed nailing of femur fractures. Patients who had femoral shaft fractures were randomized prospectively to a reamed (n = 41) or nonreamed (n = 41) femoral nailing group. Arterial blood gases were measured before and after femur fixation. Ratios of PaO2/FiO2 and alveolar arterial gradients were calculated. Pulmonary complications (acute respiratory distress syndrome) (ARDS), pneumonia, and respiratory failure) were monitored. Age, gender, fracture site, fracture type, time to nailing, length of operation, Injury Severity Score, and Abbreviated Injury Scale-thorax were similar for the two groups. No significant differences were observed in the ratio of PaO2/FiO2 ratios or alveolar arterial (A-a) gradients before and after nailing. The overall incidence of pulmonary complications was 14.6% (eight patients who had reamed nailing and four patients who had nonreamed nailing), and given the sample size, definitive conclusions could not be reached because of inadequate statistical power. We were unable to document differences in pulmonary physiologic response or clinical outcome between patients having reamed and nonreamed femoral nailing. This study may serve as a pilot investigation for other clinical investigations.
authors.affiliation: Kaiser Permanente, Los Angeles, CA, USA.
authors.forename: Iqbal A
authors.initials: IA
authors.lastname: Anwar
authors.forename: Felix D
authors.initials: FD
authors.lastname: Battistella
authors.forename: Rafael
authors.initials: R
authors.lastname: Neiman
authors.forename: Steven A
authors.initials: SA
authors.lastname: Olson
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chapman
authors.forename: H David
authors.initials: HD
authors.lastname: Moehring
mesh_terms: D000328:Adult; D001858:Bone Nails; D016009:Chi-Square Distribution; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D011446:Prospective Studies; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000453:epidemiology / Q000209:etiology*; D012129:Respiratory Function Tests; D018570:Risk Assessment; D016896:Treatment Outcome