Background: Early intramedullary nailing (IMN) of long bone fractures in severely injured patients has been\r\nevaluated as beneficial, but has also been associated with increased inflammation, multi organ failure (MOF) and\r\nmorbidity. This study was initiated to evaluate the impact of primary femoral IMN on coagulation-, fibrinolysis-,\r\ninflammatory- and cardiopulmonary responses in polytraumatized patients.\r\nMethods: Twelve adult polytraumatized patients with femoral shaft fractures were included. Serial blood samples\r\nwere collected to evaluate coagulation-, fibrinolytic-, and cytokine activation in arterial blood. A flow-directed\r\npulmonary artery (PA) catheter was inserted prior to IMN. Cardiopulmonary function parameters were recorded\r\nperi- and postoperatively. The clinical course of the patients and complications were monitored and recorded daily.\r\nResults: Mean Injury Severity Score (ISS) was 31 �± 2.6. No procedure-related effect of the primary IMN on\r\ncoagulation- and fibrinolysis activation was evident. Tumor necrosis factor alpha (TNF-a) increased significantly\r\nfrom 6 hours post procedure to peak levels on the third postoperative day. Interleukin-6 (IL-6) increased from the\r\nfirst to the third postoperative day. Interleukin-10 (IL-10) peaked on the first postoperative day. A procedure-related\r\ntransient hemodynamic response was observed on indexed pulmonary vascular resistance (PVRI) two hours post\r\nprocedure. 11/12 patients developed systemic inflammatory response syndrome (SIRS), 7/12 pneumonia, 3/12 acute\r\nlung injury (ALI), 3/12 adult respiratory distress syndrome (ARDS), 3/12 sepsis, 0/12 wound infection.\r\nConclusion: In the polytraumatized patients with femoral shaft fractures operated with primary IMN we observed a\r\nsubstantial response related to the initial trauma. We could not demonstrate any major additional IMN-related\r\nimpact on the inflammatory responses or on the cardiopulmonary function parameters. These results have to be\r\ninterpreted carefully due to the relatively few patients included.
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