Interleukin-10 release and monocyte human leukocyte antigen-DR expression during femoral nailing

This study determined the effect of femoral nailing on the expression of mo nocyte Class II antigens and interleukin-10 release and sought to different iate any differences in the release of these elements of immune reactivity in patients undergoing reamed and unreamed nailing. Thirty-two patients pre senting with an acute femoral fracture were studied. In 15 patients, the fe moral fracture was stabilized with a reamed technique and in 17 patients wi th an unreamed technique. Venous blood samples were taken at presentation, at anesthetic induction, immediately after nail insertion, and subsequently at 1, 4, and 24 hours and at 3, 5, and 7 days after surgery. Serum interle ukin-10 was measured by an enzyme-linked immunosorbent assay, and monocyte human leukocyte antigen-DR expression was quantified by how cytometry. Seru m interleukin-10 release and human leukocyte antigen-DR expression on monoc ytes showed a dear response to the nailing procedure. The group of patients undergoing a reamed femoral nailing procedure showed significantly higher interleukin-10 release and a significant depression in the expression of hu man leukocyte antigen-DR on monocytes compared with those whose nail had be en inserted unreamed, One patient in the reamed femoral nailing group died of adult respiratory distress syndrome 3 days after injury. Reamed intramed ullary nailing appears to be associated with greater impairment of immune r eactivity than is the unreamed nailing technique.