title: Stimulation of the local femoral inflammatory response to fracture and intramedullary reaming: a preliminary study of the source of the second hit phenomenon.
abstract: We have undertaken a prospective study in patients with a fracture of the femoral shaft requiring intramedullary nailing to test the hypothesis that the femoral canal could be a potential source of the second hit phenomenon. We determined the local femoral intramedullary and peripheral release of interleukin-6 (IL-6) after fracture and subsequent intramedullary reaming. In all patients, the fracture caused a significant increase in the local femoral concentrations of IL-6 compared to a femoral control group. The concentration of IL-6 in the local femoral environment was significantly higher than in the patients own matched blood samples from their peripheral circulation. The magnitude of the local femoral release of IL-6 after femoral fracture was independent of the injury severity score and whether the fracture was closed or open. In patients who underwent intramedullary reaming of the femoral canal a further significant local release of IL-6 was demonstrated, providing evidence that intramedullary reaming can cause a significant local inflammatory reaction.
authors.affiliation: Academic Department of Orthopaedic and Trauma Surgery, Leeds University, The General Infirmary at Leeds, Clarendon Wing, Great George Street, Leeds LS1 3EX, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Morley
authors.forename: R M
authors.initials: RM
authors.lastname: Smith
authors.forename: H C
authors.initials: HC
authors.lastname: Pape
authors.forename: D A
authors.initials: DA
authors.lastname: MacDonald
authors.forename: L K
authors.initials: LK
authors.lastname: Trejdosiewitz
authors.forename: P V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005264:Femoral Fractures / Q000276:immunology* / Q000601:surgery*; D005269:Femur / Q000276:immunology*; D005592:Fracture Fixation / Q000379:methods; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015850:Interleukin-6 / Q000032:analysis* / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D015850:Interleukin-6