title: Femoral nailing-related coagulopathy determined by first-hit magnitude: an animal study.
abstract: We asked whether coagulopathy worsened during femoral intramedullary nailing in the presence of lung contusion and hemorrhagic shock and whether reamed or unreamed nailing influenced these results. In 30 Merino sheep, we induced hemorrhagic shock and/or standardized lung contusion followed by femoral nailing. Six groups of five each were assigned as follows: thoracotomy control groups treated with reamed or unreamed nailing, lung contusion groups treated with reamed or unreamed nailing, and shock and lung contusion groups treated with reamed or unreamed nailing. After lung contusion alone (first hit), the serum values of antithrombin III, factor V, and fibrinogen were considerably altered after reamed and unreamed femoral nailing (second hit) 4 hours postoperatively. In the lung contusion and shock groups, we found a substantial reduction for all serum coagulative parameters between baseline and fixation after reamed and unreamed nailing. The magnitude of the first hit is increased if hemorrhagic shock is added to a lung contusion determined by hemostatic reactions. The magnitude of the injury appears equally important as the type of subsequent surgery and should be considered in planning for fracture fixation in patients at high risk for complications.
authors.affiliation: Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Room 194, A Floor, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK. pgiannoudi@aol.com
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
authors.forename: Martijn
authors.initials: M
authors.lastname: van Griensven
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
mesh_terms: D000818:Animals; D000990:Antithrombin III / Q000378:metabolism; D001778:Blood Coagulation Disorders / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D001858:Bone Nails; D003288:Contusions / Q000150:complications*; D004195:Disease Models, Animal; D005165:Factor V / Q000378:metabolism; D005264:Femoral Fractures / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D005340:Fibrinogen / Q000378:metabolism; D055370:Lung Injury; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012756:Sheep; D012771:Shock, Hemorrhagic / Q000150:complications* / Q000453:epidemiology; D013908:Thoracotomy
chemical_list: D000990:Antithrombin III; D005165:Factor V; D005340:Fibrinogen