Central hemodynamics during reamed intramedullary nailing of unilateral tibial fractures

Intramedullary nailing of a long-bone fracture results in intravasation of bone marrow contents into the right atrium and pulmonary vascular bed and, therefore, may alter cardiac and pulmonary hemodynamics.

Central hemodynamic changes were recorded in 12 healthy adults with a unilateral simple tibial fracture undergoing intramedullary nailing. The patients were cannulated with a pulmonary artery catheter. Reamed intramedullary nailing was performed during general anesthesia. Preoperative and immediate postoperative hemodynamic variables were compared and intraoperative changes studied.

During the operation, the right ventricular preload as represented by central venous pressure and the right ventricular afterload as presented by mean pulmonary arterial pressure increased significantly. Preoperative and postoperative arterial oxygen tension values demonstrated hypoxia. Abnormal pulmonary shunting and increased oxygen consumption were observed as well.

Changes in cardiac and pulmonary hemodynamics are already present after the trauma and before the reamed intramedullary nailing procedure.