Early versus delayed stabilization of femoral fractures. A prospective randomized study.

Bone, Lawrence B.; Johnson, Kenneth D.; Weigett, J.; Scheinberg, Robert

doi:10.1055/s-2006-944256

Cited by 51 publications

(63 citation statements)

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“…ETC dramatically reduces the incidence of pulmonary failure and systemic complications following polytrauma, and it is in the most severely injured patients that these improvements are most apparent [14,15].…”

Section: Principles Of Reconstruction (A) Timing Of Reconstructionmentioning

confidence: 99%

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

Evriviades

Jeffery

Cubison³

et al. 2011

Phil. Trans. R. Soc. B

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The conflict in Afghanistan has produced injuries similar to those produced from military conflicts for generations. What distinguishes the modern casualty of the conflict in Afghanistan from those of other conflicts is the effectiveness of modern field medical care that has led to individuals surviving with injuries, which would have been immediately fatal even a few years ago. These patients present several challenges to the reconstructive surgeon. These injured individuals present early challenges of massive soft-tissue trauma, unstable physiology, complex bony and soft-tissue defects, unusual infections, limited reconstructive donor sites, peripheral nerve injuries and traumatic amputations. Late challenges to rehabilitation include the development of heterotopic ossification in amputation stumps. This paper outlines the approach taken by the reconstructive team at the Royal Centre for Defence Medicine in managing these most difficult of reconstructive challenges.

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Section: Principles Of Reconstruction (A) Timing Of Reconstructionmentioning

confidence: 99%

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

Evriviades

Jeffery

Cubison³

et al. 2011

Phil. Trans. R. Soc. B

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“…Several observational studies [1][2][3][4][5][6][7][8] and one randomized study 9 have suggested that early stabilization of major long-bone fracturesthose of the shaft of the femur being most common-is associated with clinical benefits in terms of reducing the incidence of pulmonary complications and mortality. Other studies have suggested that internal fixation of long-bone fractures, either with intramedullary nailing or plate osteosynthesis, may have potentially deleterious effects in the acute setting, when systemic hypoperfusion 10 and inflammation [11][12][13] may increase susceptibility to end-organ injury and increase morbidity.…”

mentioning

confidence: 99%

Delayed Internal Fixation of Femoral Shaft Fracture Reduces Mortality Among Patients with Multisystem Trauma

Morshed

Miclau

Bembom

et al. 2009

The Journal of Bone and Joint Surgery-American Volume

129

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“…It has long been held that intramedullary nailing, such as for a diaphyseal long bone fracture, carries a risk of pulmonary complications-especially in association with concomitant chest injuries (Bone et al 1989, Behrman et al 1990, Pape et al 1993, Assal et al 2000. This has been reported to be secondary to fat embolism produced either by reaming or nail insertion (Cohn and Zieg 1996) in cases with diminished pulmonary reserve (Norris et al 2001).…”

Section: Discussionmentioning

confidence: 99%

“…3 patients died as a result of the intraoperative event. It was believed that the emboli released were secondary to reaming of the canal, but a number of reports have been published describing the same complication despite the use of unreamed nails (Bone et al 1989, Peter et al 1997, Buttaro et al 2002. The use of methylmethacrylate has also been reported to induce hypotension (Patterson et al 1991, Herrenbruck et al 2002.…”

Section: Discussionmentioning

confidence: 99%

Low risk of cardiac events during intramedullary instrumentation of lung cancer metastases

Clayer¹,

Tang²

2007

Acta Orthopaedica

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Background Instrumentation, particularly reaming, of the long bones carries the risk of embolic phenomenon. Emboli may result in pulmonary injury, which is usually manifested by desaturation. This pulmonary injury may be particularly relevant if there is diminished pulmonary reserve due to pre-existing lung disease such as lung carcinoma. In extreme cases, this can result in cardiac arrest intraoperatively.Patients and methods We reviewed 34 consecutive operations that involved instrumentation of long bones for metastases of lung carcinoma.Results Desaturation developed during 1 procedure, and there was hypotension in 5 patients. In addition, cardiac arrest occurred intraoperatively in 1 patient, which was the only fatality.Interpretation This study has shown that while emboli during femoral instrumentation may be common, significant clinical manifestations of this phenomenon are uncommon.

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Early versus delayed stabilization of femoral fractures. A prospective randomized study.

Cited by 51 publications

References 0 publications

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

Delayed Internal Fixation of Femoral Shaft Fracture Reduces Mortality Among Patients with Multisystem Trauma

Low risk of cardiac events during intramedullary instrumentation of lung cancer metastases

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