Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures - An analysis of the second hit

Citation
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
Journal title
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME
ISSN journal
0301620X → ACNP
Volume
81B
Issue
2
Year of publication
1999
Pages
356 - 361
Database
ISI
SICI code
0301-620X(199903)81B:2<356:SOTISB>2.0.ZU;2-G
Abstract
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.