%0 Journal Article
%T Intramedullary nailing of femoral shaft fractures in polytraumatized patients. a longitudinal, prospective and observational study of the procedure-related impact on cardiopulmonary- and inflammatory responses
%A Elisabeth E Husebye
%A Torstein Lyberg
%A Helge Opdahl
%A Trude Aspelin
%A Ragnhild £¿ St£¿en
%A Jan Erik Madsen
%A Olav R£¿ise
%J Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
%D 2012
%I BioMed Central
%R 10.1186/1757-7241-20-2
%X Twelve adult polytraumatized patients with femoral shaft fractures were included. Serial blood samples were collected to evaluate coagulation-, fibrinolytic-, and cytokine activation in arterial blood. A flow-directed pulmonary artery (PA) catheter was inserted prior to IMN. Cardiopulmonary function parameters were recorded peri- and postoperatively. The clinical course of the patients and complications were monitored and recorded daily.Mean Injury Severity Score (ISS) was 31 ¡À 2.6. No procedure-related effect of the primary IMN on coagulation- and fibrinolysis activation was evident. Tumor necrosis factor alpha (TNF-¦Á) increased significantly from 6 hours post procedure to peak levels on the third postoperative day. Interleukin-6 (IL-6) increased from the first to the third postoperative day. Interleukin-10 (IL-10) peaked on the first postoperative day. A procedure-related transient hemodynamic response was observed on indexed pulmonary vascular resistance (PVRI) two hours post procedure. 11/12 patients developed systemic inflammatory response syndrome (SIRS), 7/12 pneumonia, 3/12 acute lung injury (ALI), 3/12 adult respiratory distress syndrome (ARDS), 3/12 sepsis, 0/12 wound infection.In the polytraumatized patients with femoral shaft fractures operated with primary IMN we observed a substantial response related to the initial trauma. We could not demonstrate any major additional IMN-related impact on the inflammatory responses or on the cardiopulmonary function parameters. These results have to be interpreted carefully due to the relatively few patients included.ClinicalTrials.gov: NCT00981877The appropriate timing of internal stabilization of long bone fractures has been and still seems to be controversial [1-5]. Early fracture stabilization has, in several studies, been associated with reduced pulmonary complications and mortality [6-11], whereas in other studies early intramedullary nailing (IMN) has been associated with increased inflammation, multi organ fa
%K intramedullary reaming
%K intramedullary nailing
%K inflammatory response
%K femoral shaft fracture
%K long bone fracture
%K polytrauma
%K coagulation and fibrinolysis
%K cytokine activation
%K cardiopulmonary response to trauma
%U http://www.sjtrem.com/content/20/1/2