title: Influence of the timing of internal fixation of femur fractures during shock resuscitation on remote organ damage.
abstract: BACKGROUND
  Reamed intramedullary nailing is the gold standard for management of femur fractures. Nailing within 24 h is proven to reduce complications from ongoing bleeding, soft-tissue damage and pain. However, when combined with haemorrhagic shock, femur fracture and intramedullary nailing are associated with immune-mediated damage to remote organs. We studied whether delaying fracture fixation until resuscitation was succeeding would lead to a significant reduction in remote organ damage.
  
  
  METHODS
  Twenty male rabbits underwent closed femur fracture, haemorrhagic shock, resuscitation and either immediate nailing (group: ImmFix, n = 9), delayed nailing (group: DelFix, n = 8) or just splinting (group: NoFix, n = 3). Haemorrhagic shock was maintained for 60 min. Resuscitation was with shed blood and Hartmann's solution. Animals were euthanized 8 h after fixation; the lungs and small bowel were scored histologically by two pathologists.
  
  
  RESULTS
  Groups did not differ in weight, haemorrhage volume or magnitude of shock. At 8 h, there was no difference in end-organ damage between ImmFix and DelFix groups (11.3 ± 1.6 and 13.2 ± 1.6 versus 8.1 ± 1.3 and 12.9 ± 1.1, P = 0.26 between groups). However, the NoFix group had significantly greater end-organ damage when compared with the fixation at any time groups (17.3 ± 2.7 and 17.0 ± 3.3 versus 9.8 ± 1.1 and 13.1 ± 1, P = 0.01 between groups).
  
  
  CONCLUSIONS
  In this laboratory model, we have demonstrated that timely femur fracture fixation outweighs the potential harmful effects of surgery performed during haemorrhagic shock with simultaneous resuscitation. We have failed to demonstrate a difference between immediate and delayed fixation during resuscitation.
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Hardy
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yoshino
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Department of Anaesthesia and Intensive Care, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Quail
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.|Department of Traumatology, John Hunter Hospital, Newcastle, New South Wales, Australia.
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
mesh_terms: D000818:Animals; D061345:Early Medical Intervention; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D008297:Male; D009102:Multiple Organ Failure / Q000150:complications; D011817:Rabbits; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D061665:Time-to-Treatment
keywords: early total care; femur fracture; intramedullary nailing; multiple organ failure; resuscitation