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Nailing versus plating in thoracic trauma: an experimental study in sheep
F Neudeck1, G E Wozasek, U Obertacke
1Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, University of Vienna, Medical School, Austria.
The Journal of Trauma
|June 1, 1996
Summary
Intramedullary nailing for femoral fractures causes higher pressure and fat embolization than plating. Pulmonary response showed minimal differences, even with thoracic trauma.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Biomedical Engineering
Background:
- Femoral fractures are common injuries, often managed with intramedullary nailing or plating.
- Blunt thoracic trauma can complicate femoral fracture management.
- Fat embolization syndrome is a potential complication of orthopedic procedures.
Purpose of the Study:
- To compare intramedullary pressure and fat embolization during reamed vs. unreamed nailing and plating of femoral fractures.
- To assess the pulmonary hemodynamic response to these fixation methods in patients with thoracic trauma.
Main Methods:
- Measurement of femoral intramedullary pressure, fat embolization (ultrasound), and pulmonary arterial pressure.
- Comparison of reamed nailing, unreamed nailing, and plating techniques.
- Inclusion of patients with blunt thoracic trauma.
Main Results:
- Reamed nailing showed peak intramedullary pressures of 425 mm Hg (mean 205 mm Hg).
- Unreamed nailing showed peak pressures of 330 mm Hg (mean 203 mm Hg) during insertion.
- Plating resulted in minimal pressure rise (peak 67 mm Hg, mean 37 mm Hg).
- Intramedullary fixation methods led to more significant fat embolization compared to plating.
- Pulmonary arterial pressure did not significantly differ between groups postoperatively.
Conclusions:
- Intramedullary fixation of femoral fractures generates higher intramedullary pressures and greater fat/bone marrow embolization than extramedullary fixation (plating).
- Despite increased embolization, pulmonary hemodynamic response (pulmonary arterial pressure) showed minimal differences across fixation methods, even with coexisting thoracic trauma.