NAILING VERSUS PLATING IN THORACIC TRAUMA - AN EXPERIMENTAL-STUDY IN SHEEP

In this study, femoral intramedullary pressure, fat embolization, and pulmonary response were measured during reamed and unreamed nailing an d plating of femoral fractures after blunt thoracic trauma, Intramedul lary peak pressures of 425 mm Hg (mean 205 mm Hg) occurred in the ream ed nail group (group I) during reaming with the 9-mm reamer, while in the unreamed nail group (group II) peak values were seen during nail i nsertion (330 mm Hg) with a mean of 203 mm Hg. Plating never led to a pressure rise over 67 mm Hg (mean 37 mm Hg). In reamed nailing, the mo st intense embolism was identified under ultrasound imaging with the l arge awl and with the 9.0-mm reamer (mean 2.2) and in the unreamed nai l group during nail insertion (mean 2.8), Minimal echoes appeared duri ng plating, The pulmonary arterial pressure did not vary significantly postoperatively between the three groups (p < 0.08), Our findings ind icate that intramedullary fracture fixation causes a higher increase o f intramedullary pressure and more fat and bone marrow embolization th an extramedullary ones. Nevertheless, only minimal differences in the pulmonary hemodynamic response (pulmonary arterial pressure) were note d even in the presence of thoracic trauma.