Pathophysiological advantages of rinsing-suction-reaming (RSR) in a pig model for intramedullary nailing.
Although reamed intramedullary nailing has been one of the greatest advances in modern fracture care, the concomitant increase in medullary cavity pressure leads to intravasation of bone marrow content into the blood stream, an effect that can evoke serious systemic reactions. A newly developed rinsing-suction-reamer (RSR) was able to substantially reduce the pressure and bone marrow intravasation content during experimental femoral nailing. We investigated the pathophysiological effects using the RSR, testing the hypothesis that by reducing marrow fat embolization, RSR would also reduce the activation of coagulation compared with the universal AO-Reamer (AOR) and comparable to external fixation. Twenty-two pigs were treated with either simulated external fixation or reamed femoral nailing using AOR or RSR. During surgery, the intramedullary pressure was measured and intravasation of medullary material was quantified. After surgery, the pigs were kept anaesthetised and monitored for 6 h. At defined intervals, serological, hematological, and hemodynamic parameters were evaluated. The RSR was significantly superior when compared to AOR with regard to the generation of intramedullary pressure and fat embolization; however, with external fixation the values were even lower. The evaluation of other parameters revealed no clear differences between the two reamers and the external fixator. The pig model showed that RSR led to a significant reduction of the intramedullary increase in pressure and fat intravasation compared to AOR. Although the reduction of fat embolism by RSR is not associated with pathophysiological changes, RSR can have advantages for the treatment of femoral fractures.
Schult
Marc
M
Department of Trauma-, Hand-, and Reconstructive Surgery, University Hospital Münster, Waldeyerstrasse 1, D-48129 Münster, Germany. schult@uni-muenster.de
Küchle
Raphael
R
Hofmann
Alexander
A
Schmidt-Bräkling
Tom
T
Ortmann
Christian
C
Wassermann
Esther
E
Schmidhammer
Robert
R
Redl
Heinz
H
Joist
Alexander
A
D000818:Animals; D001853:Bone Marrow; D001858:Bone Nails; D004195:Disease Models, Animal; D004620:Embolism, Fat / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D016267:External Fixators / Q000009:adverse effects; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006439:Hemodynamics; D008168:Lung / Q000473:pathology; D011312:Pressure; D013552:Swine