title: Influence of preoperative 7.5% hypertonic saline on neutrophil activation after reamed intramedullary nailing of femur shaft fractures: a prospective randomized pilot study.
abstract: OBJECTIVE
  Femoral reaming and intramedullary nailing (IMN) primes polymorphonuclear leukocytes (PMNL) and thereby increases the posttraumatic systemic inflammatory response. Resuscitation with hypertonic saline (HTS) attenuates PMNL activation after trauma-hemorrhage. We hypothesized that preoperative administration of 7.5% HTS attenuates PMNL priming after IMN of unilateral femur shaft fractures compared with 0.9% normal saline.
  
  
  METHODS
  Prospective, randomized, double-blind study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  Twenty patients between 18 and 80 years of age with an Injury Severity Score less than 25 and a unilateral femur shaft fracture amenable to IMN fixation within 24 hours after injury.
  
  
  METHODS
  Patients were allocated to equally sized HTS or normal saline treatment groups (n = 10) before surgery. Solutions were administered in a blinded bag as a single bolus of 4 mL/kg body weight immediately before surgery. Whole blood samples were collected directly before saline application (t0) and at 6, 12, and 24 hours after surgery.
  
  
  METHODS
  PMNL surface expression of CD11b and CD62L, as determined by flow cytometry analysis.
  
  
  RESULTS
  Demographic characteristics of both treatment groups were comparable. Baseline expression of CD11b and CD62L cell markers was in a similar range in the two cohorts. The expression levels of CD11b were comparable between the two groups throughout the observation time, whereas CD62L levels were significantly higher in the HTS group at 6 and 24 hours after surgery.
  
  
  CONCLUSIONS
  Preoperative infusion of HTS appears to exert an anti-inflammatory effect by attenuating the extent of postoperative PMNL activation after reamed IMN for femoral shaft fractures.
authors: Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado Denver, School of Medicine, Denver, CO 80204, USA.
authors: Juan F
authors: JF
authors: Agudelo
authors: Michael A
authors: MA
authors: Flierl
authors: Wade R
authors: WR
authors: Smith
authors: Ernest E
authors: EE
authors: Moore
authors: Allison E
authors: AE
authors: Williams
authors: Philip C
authors: PC
authors: Eckels
authors: Steven J
authors: SJ
authors: Morgan
authors: Philip F
authors: PF
authors: Stahel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000276:immunology* / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000276:immunology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation / Q000187:drug effects*; D011292:Premedication / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D012462:Saline Solution, Hypertonic