Influences of Different Methods of Intramedullary Femoral Nailing on Lung Function in Patients With Multiple Trauma

Trauma Care in Germany: An Inclusive System

“…In addition, certain injury profiles were identified that are especially prone to develop such complications (borderline patient) [43]. Also, certain surgical procedures were reportedly associated with defined risks [44,48,53]. Depending on the type of surgery, the presence of specific comorbidities can be associated with a predictable increase in inflammatory markers [45,46,54,59,61].…”

Current Concepts of Respiratory Insufficiency Syndromes After Fracture

“…Many of these patients also have evidence of SIRS and concerns have been raised about the safety of early reamed nailing because the procedure may act as a secondary 'hit', which may trigger the development of ARDS. 9,19,20,89 Modifications to the basic protocol of early reamed nailing have been examined including the use of temporary external fixation until the inflammatory response has settled or resuscitation is complete, 88,91 the employment of different methods of fixation such as unreamed nails 78,92,93 or compression plates, 94,95 or of techniques designed to reduce fat embolisation during reamed nailing including venting, 96 lavage of the medullary canal 86 or an altered design of reamer.…”

Pulmonary Dysfunction in Patients with Femoral Shaft Fracture Treated with Intramedullary Nailing

“…Reaming of the medullary canal may increase the risk of fat emboli and the prevalence of adult respiratory distress syndrome in patients with concurrent pulmonary injury. Although the findings of Pape et al [2][3][4]20 have not been corroborated by other investigators 21 , concern remains regarding the effect of intramedullary nailing of femoral shaft fractures on the pulmonary function of patients with multiple injuries. If objective physiologic or clinical measures of pulmonary dysfunction were to show an adverse effect of nailing or reaming, then a compelling argument could be made against performing one or both procedures.…”

“…A large bolus of embolized marrow can block perfusion to a portion of the well-ventilated lung, resulting in a high ventilation-to-perfusion ratio or increased alveolar dead space [7][8][9][10][11][12][13][14][15][16][17] . The method used to prepare the medullary canal may determine the amount of bone marrow extrusion during intramedullary nailing 3,[18][19][20] . Pape et al proposed that reaming of the femoral canal may exacerbate lung damage in patients with chest injury [2][3][4] .…”

“…The method used to prepare the medullary canal may determine the amount of bone marrow extrusion during intramedullary nailing 3,[18][19][20] . Pape et al proposed that reaming of the femoral canal may exacerbate lung damage in patients with chest injury [2][3][4] . Reaming of the medullary canal may increase the risk of fat emboli and the prevalence of adult respiratory distress syndrome in patients with concurrent pulmonary injury.…”