SYSTEMIC RELEASE OF PROSTAGLANDINS FOLLOW ING ELECTIVE ORTHOPEDIC-SURGERY COMPARED WITH FRACTURES

Prostanoids are inflammatory mediators released from endothelial cells following (local) tissue damage. Bone fractures are associated with a discharge of high local energy, thus resulting in marked tissue traum a in the area of cavitation. Plasma levels of prostanoids therefore mi ght be possible markers of the inflammatory response and the severity of trauma. The aim of this study was to elucidate the release of arach idonic acid (AA) metabolites following elective surgery (osteotomy) in comparison to long bone fractures of the lower extremity. 41 patients with osteotomy (group A) and 18 patients with bone damage (group B) w ere monitored perioperatively with regard to the release of prostacycl in (PGI(2)), thromboxane (TxA(2)), and prostaglandin (PG)F-2 alpha. Al l AA metabolites revealed a clear-cut release following trauma. Despit e the longer lasting interval between trauma and the first blood sampl ing on hospital admission in group B there was a markedly pronounced r elease of prostanoids in patients with fractures compared to osteotomy . These results suggest that the damage to the soft tissue surrounding the fracture zone rather causes the systemic inflammatory response th an the bone injury (fracture; osteotomy) itself. Our results support t he empirical recommendation of external fracture fixation in large sof t tissue injury and open fractures. The systemic release of prostanoid s, thus influencing vascular permeability and resistance explain the l ikely impairment of pulmonal function often observed after long bone f ractures.