Nailing Versus Plating in Thoracic Trauma

Abstract

In this study, femoral intramedullary pressure, fat embolization, and pulmonary response were measured during reamed and unreamed nailing and plating of femoral fractures after blunt thoracic trauma. Intramedullary peak pressures of 425 mm Hg (mean 205 mm Hg) occurred in the reamed nail group (group I) during reaming with the 9-mm reamer, while in the unreamed nail group (group II) peak values were seen during nail insertion (330 mm Hg) with a mean of 203 mm Hg. Plating never led to a pressure rise over 67 mm Hg (mean 37 mm Hg). In reamed nailing, the most intense embolism was identified under ultrasound imaging with the large awl and with the 9.0-mm reamer (mean 2.2) and in the unreamed nail group during nail insertion (mean 2.8). Minimal echoes appeared during plating. The pulmonary arterial pressure did not vary significantly postoperatively between the three groups (p < 0.08). Our findings indicate that intramedullary fracture fixation causes a higher increase of intramedullary pressure and more fat and bone marrow embolization than extramedullary ones. Nevertheless, only minimal differences in the pulmonary hemodynamic response (pulmonary arterial pressure) were noted even in the presence of thoracic trauma.

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

“…This model allowed for comparison to humans owing to the anatomic and physiological comparability of the lung 20 and the dimensions of the skeleton 21 and also for comparison with other studies. [22][23][24][25][26] Because most available enzymatic test kits are not suitable for sheep's blood, we decided to conduct the present experiments with pigs. Most of the clinically established physiological coagulation tests are crossreactive with this species, and a certain number of comparative studies also exist.…”

Fat embolism

“…The normal marrow pressure is 30±50 mmHg but can be increased up to 600 mmHg during intramedullary reaming [58]. Intramedullary devices are associated with higher pressures within the marrow cavity and more FE than extramedullary fixation [59,60]. Ultrasonographically, most emboli occur during opening and manipulation of the intramedullary cavity [61].…”

“…Surgical fixation of fractures increases intramedullary pressure and causes mobilisation of marrow fat [60]. The relationship between intramedullary pressure and FE has led to the development of specific strategies in trauma surgery [90].…”

Pathological Evaluation of Venous Emboli During Total Hip Arthroplasty

“…A greater amount of bone dust may enter the vessels at insertion of femoral component because some reports indicated that intramedullary pressure 10 increased more by using bone cement [5,15,16]. At relocation of hip joint, some bone dust accumulated in the leg vein [6] may have been released and then flowed into RA.…”