[Pulmonary complications following intramedullary stabilization of long bones. Effect of surgical procedure, time and injury pattern]

Early operative treatment of femur fractures is recommended in multiple trauma patients regardless of the pattern of injuries. However, in our clinical experience primary (< 24 h) reamed nailing of a femur shaft fracture in multiple trauma patients is associated with an unusually high number of pulmonary complications, especially in the presence of additional chest trauma. Based on these subjective observations, two clinical studies were done: (1) retrospectively (766 multiple traumatized patients), a higher ARDS incidence in patients with thoracic trauma and primary intramedullary nailing was found; (2) in a prospective clinical study patients submitted to femoral reaming showed a significant increase in pulmonary arterial pressure during the reaming phase, as well as transient worsening of pulmonary function (PaO2/FiO2). The changes were less pronounced in a group of patients undergoing femur nailing by an unreamed procedure. The presence of additional pulmonary trauma predisposes to the development of ARDS. Likewise, injuries associated with severe bleeding are known to predispose to capillary damage, resulting in pulmonary edema. In this group of patients, additional insults to the lung by operative procedures do not appear justified. Primary (< 24 h) reamed nailing has potentially negative effects on the lung and should be avoided if additional chest trauma is present in a polytrauma patient.