Similar central hemodynamics but increased postoperative oxygen consumption in unreamed versus reamed intramedullary nailing of femoral fractures.
BACKGROUND
Patients undergoing intramedullary nailing of long bone fractures have pathologically altered pulmonary vascular tone, right heart strain, and transient impairment of pulmonary gas exchange. The purpose of this study was to examine the acute differences in cardiopulmonary variables between reamed and unreamed nailing techniques in 18 (9 + 9) healthy patients with unilateral femoral shaft fractures.


METHODS
Intramedullary nailing was performed under general anesthesia within 12 hours after the trauma. For blood sampling, recording, and measurements, the patients were cannulated with radial artery and pulmonary artery catheters. Changes in central hemodynamics and oxygenation were studied pre-, peri-, and postoperatively for 16 to 20 hours.


RESULTS
Abnormally high pulmonary shunting (23 +/- 12% in the reamed and 27 +/- 11% in the unreamed group) was observed before the operation. The trends of all variables were very similar in both groups except for the last phase in which the mixed venous oxygen saturation tended to be lower (65 +/- 8 vs. 70 +/- 5%) and the oxygen consumption index was higher (186 +/- 21 vs. 151 +/- 20 mL/min/m) in the unreamed group than in the reamed group (p < 0.05). The timepoints most strenuous to the heart were at the end of operation and in the recovery room.


CONCLUSIONS
The unreamed intramedullary nailing technique does not offer any advantage in cardiopulmonary variables over the reamed technique. In both groups, there was considerable deviation in over 10 cardiopulmonary variables from normal reference values during the study. We suggest the use of invasive monitoring on patients with a long bone fracture and poor preoperative oxygenation or a history of cardiopulmonary or cardiac disease.
Helttula
Ilmo
I
Department of Surgery, University of Turku, Turku, Finland.
Karanko
Meri
M
Gullichsen
Eero
E
D000328:Adult; D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology; D001858:Bone Nails; D002302:Cardiac Output / Q000502:physiology; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000379:methods*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology*; D011184:Postoperative Period; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology
D006454:Hemoglobins