The Stress Response to Bilateral Femoral Fractures: A Comparison of Primary Intramedullary Nailing and External Fixation

Gray, Andrew; White, T O; Clutton, Eddie; Christie, James H.; Hawes, B.; Robinson, C. M.

doi:10.1097/bot.0b013e31819194c6

Cited by 32 publications

(31 citation statements)

References 35 publications

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“…The coagulation response has been evaluated by monitoring the levels of antithrombin III (AT-III), factor V, fibrinogen [23,24,26,48], and D-dimers [26,54]. AT-III and factor V levels were reduced in control groups in which RFN and UFN were performed without a preceding first hit [23,68].…”

Section: Resultsmentioning

confidence: 99%

“…All the models used reamed femoral nailing (RFN), or unreamed femoral nailing (UFN) as the second hit [20, 23, 26, 35, 39, 45, 48-52, 54, 60, 68, 70, 71]. Control groups treated by plate osteosynthesis [45,48,60], external fixators [24,26,51], and tibia intramedullary nailing [71] could be evaluated and were used for comparison. The variables that were used as markers for quantification of the second-hit phenomena included factors related to coagulation, hemodynamic, pulmonary function and permeability, and incidence of fat embolism (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…Other species used were dogs [39,60] and mice [69]. The six conditions that were used as first hit were: hemorrhagic shock [16,23,24,35,42,43,[48][49][50][51][52]71], lung contusion [20,23,26,[48][49][50][51][52]54], high-energy trauma/fracture generation [24,39,43,45,68,69], vasogenic brain edema [35], fat embolization [60], and an acute respiratory distress syndrome (ARDS)-like condition induced by chemical agents [70]. All the models used reamed femoral nailing (RFN), or unreamed femoral nailing (UFN) as the second hit [20, 23, 26, 35, 39, 45, 48-52, 54, 60, 68, 70, 71].…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Intramedullary Nailing as a ‘Second Hit’ Phenomenon in Experimental Research: Lessons Learned and Future Directions

Lasanianos

Kanakaris

Giannoudis

2010

Clinical Orthopaedics &Amp; Related Research

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Intramedullary Nailing as a ‘Second Hit’ Phenomenon in Experimental Research: Lessons Learned and Future Directions

Lasanianos

Kanakaris

Giannoudis

2010

Clinical Orthopaedics &Amp; Related Research

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“…Gray et al conducted as study to compare the physiologic effects of external femoral fi xation with those of intramedullary stabilization over the fi rst 24 h after femoral fracture (Gray et al 2009 ) . Under terminal anaesthesia, bilateral highenergy femoral fractures and hypovolemic shock were produced using a pneumatic actuator.…”

Section: Sheep and Goatsmentioning

confidence: 98%

Preclinical Animal Models for Segmental Bone Defect Research and Tissue Engineering

Reichert¹,

Berner²,

Saifzadeh³

et al. 2013

Regenerative Medicine

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Commonly applied therapies to achieve bone reconstruction or function are restricted to the transplantation of autografts and allografts, or the implantation of metal devices or ceramic-based implants. Bone grafts generally possess osteoconductive and osteoinductive properties. They are, however, limited in access and availability and harvest is associated with donor site morbidity, hemorrhage, risk of infection, insuf fi cient transplant integration, and graft devitalisation. As a result, recent research focuses on the development of alternative therapeutic concepts. Available literature indicates that bone regeneration has become a focus area in the fi eld of tissue engineering. Hence, a considerable number of research groups and commercial entities work on the development of tissue engineered constructs to aid bone regeneration. However, bench to bedside translations are still infrequent as the process towards approval by regulatory bodies is protracted and cost-intensive. Approval requires both comprehensive in vitro and in vivo studies necessitating the utilisation of large preclinical animal models. Consequently, to allow comparison between different studies and their outcomes, it is essential to standardize animal models, fi xation devices, surgical procedures and methods of taking measurements to produce reliable data pools as a base for further research directions. The following chapter reviews animal models of the weight-bearing lower extremity utilized in the fi eld, which include representations of fracture-healing, segmental bone defects, and fracture non-unions.

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“…A bilateral femoral fracture and shock model in rabbits revealed higher systemic IL-6, IL-10 and TNF-a levels and increased lung damage in animals after reamed intramedullary nailing when compared to external fixation [69]. Gray et al [70] used a bilateral femoral fracture model in sheep accompanied by hypovolemic shock to study the impact of reamed intramedullary nailing versus external fixation. Transesophageal echocardiography showed increased embolic load in the nailing group but without any impact on the metabolic base excess or plasma coagulation parameters.…”

Section: Insights From Basic Sciencementioning

confidence: 99%

The influence of coagulation and inflammation research on the improvement of polytrauma care

Perl

Huber‐Lang

Gebhard

2011

Eur J Trauma Emerg Surg

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Treatment guidelines and management principles of polytrauma patients are largely derived from experience, supplemented by the results of few clinical studies. Their clinical impact on survival outcome is rarely scientifically evaluated. Hence, research algorithms need to be developed which enable a rapid and profound reevaluation of the current treatment strategies in polytrauma care and which provide a solid basis for the assessment of future treatment options. Such new concepts might include a more individualized approach and a better identification of operative windows for early definitive care. Since polytrauma results in a complex physiological and immunological disorder, which is additionally influenced by multiple confounding variables, it is challenging to establish such novel algorithms by clinical research only. In this regard, the well defined parameters in valid basic science models can provide a solid base for evaluating current concepts and investigating future treatment options. Here we have analyzed the contribution of basic science to well-established concepts in polytrauma care, such as the management of trauma induced coagulopathy or the damage control orthopedics concept. Many of these ideas moved from previous basic science activities to clinical studies but in many cases the direct effects of basic science on clinical trials or even clinical management strategies often remain elusive. Nevertheless, the knowledge which is created on a daily basis by basic science studies acts as an invaluable data pool, which can be accessed and combined for the clinical researcher to develop and address clinically relevant questions, providing them with a comprehensive pool of information to carefully plan and conduct their clinical trials. This may then subsequently lead to the development of new management principles for polytrauma patients.

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The Stress Response to Bilateral Femoral Fractures: A Comparison of Primary Intramedullary Nailing and External Fixation

Abstract: A higher pulmonary embolic load can be expected during early intramedullary femoral fracture stabilization compared with primary external fixation. However, the degree of stimulation to systemic coagulation and pulmonary inflammation by each type of surgery was comparable.

Cited by 32 publications

References 35 publications

Intramedullary Nailing as a ‘Second Hit’ Phenomenon in Experimental Research: Lessons Learned and Future Directions

Intramedullary Nailing as a ‘Second Hit’ Phenomenon in Experimental Research: Lessons Learned and Future Directions

Preclinical Animal Models for Segmental Bone Defect Research and Tissue Engineering

The influence of coagulation and inflammation research on the improvement of polytrauma care

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