Pv. Giannoudis et al., Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures - An analysis of the second hit, J BONE-BR V, 81B(2), 1999, pp. 356-361
Citations number
28
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
It has been suggested that reamed intramedullary nailing of the femur shoul
d be avoided in-some patients with multiple injuries, We have studied prosp
ectively the effect of femoral reaming on the inflammatory process as impli
cated in the pathogenesis of acute respiratory distress syndrome (ARDS) and
multiple-organ failure (MOF). We studied changes in the levels of serum in
terleukin-6 (IL-6) (proinflammatory cytokine), neutrolphil CD11b (C3) recep
tor expression (activated neutrophil adhesion molecule), serum soluble intr
acellular adhesion molecule(s-ICAM-1), serum soluble E-selectin (the solubl
e products of endothelial adhesion molecules) and plasma elastase (neutroph
il protease) in a series of patients with femoral fractures treated by nail
ing, We have also compared seamed nailing with unreamed nailing.
We found that the levels of serum IL-6 and elastase rose significantly duri
ng the nailing procedure indicating a measurable 'second hit'. There was no
clear response in leukocyte activation and no difference in the release of
endothelial adhesion molecule markers, There was no significant difference
between groups treated by reamed and unreamed nailing, Although clinically
unremarkable, the one patient who died from ARDS was shown to be hyperstim
ulated after injury and again after nailing, suggesting the importance of a
n excessive inflammatory reaction in the pathogenesis of these serious prob
lems.
Our findings have shown that there is a second hit associated with femoral
nailing and suggest that the degree of the inflammatory reaction may be imp
ortant in the pathogenesis of ARDS and MOF.