Die klinische Wertigkeit biochemischer Faktoren beim Polytrauma

Nast-Kolb, D.; Jochum, Marianne; Waydhas, Christian; Schweiberer, L.

doi:10.1007/978-3-642-76509-4

Cited by 27 publications

(24 citation statements)

References 50 publications

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“…Definitive osteosynthesis by medullary nailing is only conducted after stabilization of the clinical situation. 15 However, fracture healing with a fixator in place is associated with a significant rate of complications. 16 Therefore, in most cases, an early elective conversion to an intramedullary stabilizing technique takes place, 17 although in retrospective studies, an infection rate up to 13.3% was reported.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Schult

Küchle²,

Hofmann³

et al. 2006

Journal Orthopaedic Research

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Although reamed intramedullary nailing has been one of the greatest advances in modern fracture care, the concomitant increase in medullary cavity pressure leads to intravasation of bone marrow content into the blood stream, an effect that can evoke serious systemic reactions. A newly developed rinsing-suction-reamer (RSR) was able to substantially reduce the pressure and bone marrow intravasation content during experimental femoral nailing. We investigated the pathophysiological effects using the RSR, testing the hypothesis that by reducing marrow fat embolization, RSR would also reduce the activation of coagulation compared with the universial AOReamer (AOR) and comparable to external fixation. Twenty-two pigs were treated with either simulated external fixation or reamed femoral nailing using AOR or RSR. During surgery, the intramedullary pressure was measured and intravasation of medullary material was quantified. After surgery, the pigs were kept anaesthetised and monitored for 6 h. At defined intervals, serological, hematological, and hemodynamic parameters were evaluated. The RSR was significantly superior when compared to AOR with regard to the generation of intramedullary pressure and fat embolization; however, with external fixation the values were even lower. The evaluation of other parameters revealed no clear differences between the two reamers and the external fixator. The pig model showed that RSR led to a significant reduction of the intramedullary increase in pressure and fat intravasation compared to AOR. Although the reduction of fat embolism by RSR is not associated with pathophysiological changes, RSR can have advantages for the treatment of femoral fractures.

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Section: Discussionmentioning

confidence: 99%

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Schult

Küchle²,

Hofmann³

et al. 2006

Journal Orthopaedic Research

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show abstract

“…All available studies have shown a positive relation between persistently elevated plasma elastase and the incidence and severity of ARDS, sepsis/SIRS, and MOF in several conditions such as major trauma, burns, pancreatitis, and peritonitis (Duswald et al 1985;Nuytinck et al 1986b;Dittmer et al 1986;Zheutlin et al 1986;Nerlich et al 1986;Lang et al' 1988;Schoeffel et al 1989;Pacher et al' 1989;Tanaka et al 1991;Nast-Kolb et al 1991). A few studies found elastase to predict MOF (Nuytinck et al 1986b;Pacher et al 1989;Lang et al 1988;Nast-Kolb et al 1991).…”

Section: Clinical Datamentioning

confidence: 91%

“…Plasma elastase values above 500 ng/ml at day 3 post-trauma predicted subsequent severe MOF with 95% specificity and 69% sensitivity. The negative predictive value was 93% (Nast-Kolb et al 1991). The present evidence thus suggests an important role for elastase as a marker of PMN activity and possibly as a predictor of ARDS and MOE…”

Section: Clinical Datamentioning

confidence: 95%

“…A few studies found elastase to predict MOF (Nuytinck et al 1986b;Pacher et al 1989;Lang et al 1988;Nast-Kolb et al 1991). Plasma elastase at admission had the highest sensitivity (840/0) but the lowest specificity (39%) in predicting MOF after trauma (Nast-Kolb et al 1991).…”

Section: Clinical Datamentioning

confidence: 97%

“…Plasma neopterin levels above 30 mg/dl on day 3 post-injury predicted subsequent severe MOF with 70070 sensitivity and 93070 specificity. The negative predictive value was 93070 (Nast- Kolb et al 1991).…”

Section: Clinical Datamentioning

confidence: 99%

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