THROMBOXANE - COFACTOR OF PULMONARY DISTURBANCES IN INTRAMEDULLARY NAILING

Pulmonary complications during and after intramedullary nailing partic ularly in trauma patients have directed clinical interest to thromboem bolic events and metabolic alterations, as found in different methods of fracture stabilisation. In 30 patients (mean age 34 years) isolated , closed or I-degrees open fractures of the tibia were operated on in three groups with reamed nailing (RN; n=11), unreamed nailing (UN; n=1 1) and external fixation (EF; n=8) respectively. In blood samples of t he femoral vein of the fractured limb, a 5 - 7 fold increase of the th romboxane (TXB2) concentration was found in all patients. However, dif ferences of TXB2 concentrations in the arterial blood after passage of the lungs were conspicuous. The highest arterial TXB2 concentrations were found in connection with RN, followed by UN and finally EF. The t ranspulmonary TXB2-clearance displayed the following relationship: EF > UN > RN (5.7 : 4,4 : 2.2). A similar correlation was found for PGF2a lpha while other arachidonic acid metabolites showed no significant be haviour. TXB2 and PGF2alpha cause bronchoconstriction, pulmonary vasoc onstriction ana aggregation of thrombocytes. These pulmonary disturban ces may results in ARDS, a feared complication after intramedullary na iling. Conclusion: Early fracture stabilisation particularly in severe ly injured patients is an established procedure. To prevent pulmonary disturbances the external fixator is preferrable to the UN and finally the RN. Our data suggest that for the prevention of pulmonary disturb ances EF is superior to UN and RN.