OTA 2006 Posters
Scientific Poster #2 Polytrauma
Effects of Reamed or Unreamed Intramedullary Nailing Under Nondamaged
Conditions on Pulmonary Function in Sheep: Using "Second-Hit"
Alone Model
Shinichi Aoki, MD1 (*); Kazuhiko Yokoyama, MD2
(*);
Moritoshi Itoman, MD3 (*);
1Atsugi Hokubu Hospital, Atsugi, Japan;
2Machida Municipal Hospital, Tokyo, Japan;
3Kitasato University School of Medicine, Sagamihara, Japan
Purpose: Pulmonary damage after reamed or unreamed femoral nailing
has been controversial in clinical and experimental studies. We investigated
changes in pulmonary function and coagulatory response in normal lungs of
sheep after reamed or unreamed intramedullary nailing of an unfractured
femur. We performed these experiments in order to evaluate deleterious effects
on pulmonary and systemic function induced by reamed or unreamed femoral
nailing without confounding factors, especially at the acute phase. In other
words, there is no "first-hit" in this experiment and we focused
on reamed or unreamed"nailing, which could associate with the so-called
"second-hit" to pulmonary disorders.
Methods: We used 3 groups of sheep (each group, n = 6): reamed femoral
nailing (RFN), unreamed femoral nailing (UFN), and sham control group. Femoral
osteotomies and lung contusions were not made. Hemodynamic monitoring data
and blood gas data (BGD) were recorded, and blood samples for biochemistry
(antithrombin III, lipid peroxidase, and fibrinogen) were collected 0 to
6 hours after nailing. Bronchoalveolar lavage fluid (BALF) and myeloperoxidase
(MPO) activity in pulmonary tissue were analyzed 6 hours after nailing.
Results: There were no significant differences in time course of
hemodynamic monitoring data, BGD, or biochemical data among the 3 groups.
In BALF analysis, the lipid-laden cell count in the RFN group was higher
than those of the other groups, and MPO activity was highest in the RFN
group.
Conclusion: The present results indicate that, under nonfractured
conditions, normal lung conditions, lack of impending fat embolism status,
and nonhypovolemic conditions, RFN does not influence pulmonary function
at the physiologic level, and does not induce a hypercoagulatory response
at the acute stage. RFN can lead to the flow of fat globules into the pulmonary
circulation. However, under normal conditions, RFN can lead to leukocyte
activation in lung tissue, without worse alteration of alveolar permeability
when compared to that of UFN, in the acute postoperative course.
If noted, the author indicates something of value received.
The codes are identified as a-research or institutional support; b-miscellaneous
funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts
disclosed, and *disclosure not available at time of printing.
·
The FDA has not cleared this drug and/or medical device for the use
described in this presentation (i.e., the drug or medical device is being
discussed for an "off label" use). · · FDA
information not available at time of printing.