Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures

Background: Intramedullary nailing of a long-bone fracture results in intra vasation of bone marrow contents into the right atrium and pulmonary vascul ar bed and, therefore, may alter cardiac and pulmonary hemodynamics. Methods: Central hemodynamic changes were recorded in 12 healthy adults wit h a unilateral simple tibial fracture undergoing intramedullary nailing. Th e patients were cannulated with a pulmonary artery catheter, Reamed intrame dullary nailing was performed during general anesthesia. Preoperative and i mmediate postoperative hemodynamic variables were compared and intraoperati ve changes studied. Results: During the operation, the right ventricular preload as represented by central venous pressure and the right ventricular afterload as presente d by mean pulmonary arterial pressure increased significantly, Preoperative and postoperative arterial oxygen tension values demonstrated hypoxia. Abn ormal pulmonary shunting and increased oxygen consumption were observed as well. Conclusion: Changes in cardiac and pulmonary hemodynamics are already prese nt after the trauma and before the reamed intramedullary nailing procedure.