Influence of One Step Reaming vs. Unreamed Nailing on Intramedullary Pressure Changes and Systemic Parameters

Abstract

The influence of one step reaming on fat intravasation vs. unreamed nailing was compared in this animal shock model. Intramedullary pressure (IMP) changes, respiratory and hemodynamic parameters were measured continuously during the operation. The animals were operated on both femora. The amount of fat intravasation was measured by modified Gurd test and transesophageal sonography (TES). Despite higher IMP-values the systemic response was comparable in both groups. The second operated side caused more systemic dysfunction as the first side.

Key words

Femoral shaft fracture - one step reaming - intramedullary pressure - spiral reamer

References

• 1 Beckman S B, Scholten D J, Bonneli B W. et al . Long bone fractures in the polytrauma patient: The role of early operative fixation.  Am Surg. 1989;  56 356-359
• 2 Goris R J, Gimbrere J S, van Niekerk J L. et al . Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient.  J Trauma. 1982;  22 895-899
• 3 Johnson K D, Cadambi A, Seibert G B. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: Effect of early operative stabilization of fractures.  J Trauma. 1985;  15 375-379
• 4 Kröpfl A, Davies J, Berger U, Hertz H, Schlag G. Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing.  J Orthop Res. 1999;  17 261-268
• 5 Mousavi M, David R, Ehteshami J, Pajenda S, Vécsei V. Pressure changes during reaming with different parameters and reamer designs.  Clin Orthop. 2000;  373 295-303
• 6 Pape H C, Regel G, Dwenger A. et al . Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma.  J Trauma. 1993;  35 709-716
• 7 Riska E B, von Bonsdorff H, Hakkinen S. et al . Primary operative fixation of long bone fractures in patients with multiple injuries.  J Trauma. 1977;  17 111-116
• 8 Sturm J A, Pape H C, Regel G, Dwenger A, Tscherne H. Early intramedullary nailing of long bone fractures: A risk for the multiple trauma patient?.  Orthop Trans. 1992;  16 223-224
• 9 Tornetta P, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing.  J Orthop Trauma. 2000;  14 15-19
• 10 Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing: Demonstrated by intraoperative echocardiography.  Injury. 1993;  24 (Suppl 3) 73-81