Similar Central Hemodynamics and Oxygenation in Reamed and Unreamed Intramedullary Nailing of Tibial Fractures

Abstract

Changes in cardiac and pulmonary hemodynamics are already present after the trauma and before the intramedullary nailing procedure.

Similar Central Hemodynamics but Increased Postoperative Oxygen Consumption in Unreamed Versus Reamed Intramedullary Nailing of Femoral Fractures

“…6,7 Indeed, parallel findings were described more than 40 years ago. 8 Yet, fracture patients with comorbidity may still die of pulmonary fat embolism and acute cor pulmonale.…”

“…The femoral fracture caused the heart to pump about one liter more per minute as compared what has been reported on tibial fractures. 6 The baseline shunt fraction was high in both groups (23% and 27%) as compared with the normal values (2% to 5%) but just slightly higher as compared with those with tibial fractures at baseline (21% to 22%). 6 Our earlier studies have shown that the stabilization of tibial fractures does not, in it self, increase shunting but this phenomenon is rather a consequence of the trauma.…”

“…An a priori sample size was estimated (to 10 ϩ 10) based on the results from our previous fracture studies. 6,11 The patients were interviewed and examined clinically by one of the authors (I.H. ), and the fractures were classified according to the Arbeitsgemeinshaft für Osteosynthesefragen (AO) system.…”

“…2,3 The superiority of the unreamed technique has, however, been challenged by experimental 4 and clinical studies. 5,6 There is evidence that embolic particles are found in the lungs of patients in association with both techniques; no protection from pulmonary disturbances is guaranteed even if the unreamed nail is used. 5,4 The intraoperative cardiopulmonary changes in 13 patients with isolated femoral fractures subjected to reamed intramedullary nailing have been studied; 7 however, there is a lack of postoperative data and data on patients who have undergone unreamed nailing.…”

“…9,10 In an isolated tibial fracture model there was no difference in cardiopulmonary variables between the two nailing techniques. 6 The volume of fatty bone marrow contents to be released to circulation is, however, considerably larger in the femur than in the tibia. To further test the hypothesis that the unreamed technique is superior to the reamed technique, we studied patients with isolated femoral fractures.…”