2006
DOI: 10.1097/01.ta.0000243888.31434.b1 View full text |Buy / Rent full text
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Abstract: The unreamed intramedullary nailing technique does not offer any advantage in cardiopulmonary variables over the reamed technique. In both groups, there was considerable deviation in over 10 cardiopulmonary variables from normal reference values during the study. We suggest the use of invasive monitoring on patients with a long bone fracture and poor preoperative oxygenation or a history of cardiopulmonary or cardiac disease.

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“…1 This can be catalyzed by the combination of multitrauma of the body with fracture of long bones that are treated with reaming and intramedullary nailing. [2][3][4][5][6][7][8][9][10][11][12] In 106 consecutive multitrauma patients with femoral shaft fractures, Pape et al 12 found that 47% had an associated significant thoracic injury. Manipulation of the femur at the time of fracture fixation, and more specifically instrumentation and pressurization of the femoral intramedullary canal, results in the intravasation of medullary contents, including fat, into the systemic circulation.…”
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rupbmjkragerfmgwileyiopcupepmcmbcthiemesagefrontiersapsiucrarxivemeralduhksmucshluniversity-of-gavle
“…1 This can be catalyzed by the combination of multitrauma of the body with fracture of long bones that are treated with reaming and intramedullary nailing. [2][3][4][5][6][7][8][9][10][11][12] In 106 consecutive multitrauma patients with femoral shaft fractures, Pape et al 12 found that 47% had an associated significant thoracic injury. Manipulation of the femur at the time of fracture fixation, and more specifically instrumentation and pressurization of the femoral intramedullary canal, results in the intravasation of medullary contents, including fat, into the systemic circulation.…”
mentioning
“…Conversely, Helttula et al concluded that reamed versus unreamed nails have no significant difference in their impact on haemodynamics. Yet, he found unreamed nails increase postoperative oxygen consumption 28. Also, with the advent of the reamer–irrigator–aspirator, Dunn et al showed that a significantly decreased fat emboli burden was detected by transoesophageal echocardiogram when compared with a conventional reamer 25.…”
Section: Discussionmentioning
“…No está recomendada la estabilización precoz (en las primeras 24 horas) de fracturas diafisarias mediante clavos intramedulares fresados en pacientes politraumatizados por producir un aumento de complicaciones hemodinámicas cardiopulmonares y síndrome de distress respiratorio 173,246,288,289,295,322,403 . En otros estudios no se observan, sin embargo, diferencias significativas en las afecciones cardiopulmonares ni aumento de las complicaciones de ETEV por el tratamiento con clavos intramedulares fresados y sin fresar 11,55,169 . Sí hay evidencia en diferentes estudios sobre el efecto activador de la coagulación que ejerce el fresado intramedular 182 .…”
Section: Fresado De La Cavidad Medularunclassified