0
Articles   |    
The Effects of Femoral Intramedullary Reaming on Pulmonary Function in a Sheep Lung Model*
PAUL J. DUWELIUS, M.D.†; ROGER HUCKFELDT, M.D.‡; RICHARD J. MULLINS, M.D.†; TAKAKIRO SHIOTA, M.D., PH.D.†; T. SCOTT WOLL, M.D.†; KENNETH H. LINDSEY, M.D.†; DONNA WHEELER, PH.D.†, PORTLAND, OREGON
View Disclosures and Other Information
Investigation performed at Oregon Health Sciences University, Portland
J Bone Joint Surg Am, 1997 Feb 01;79(2):194-202
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Two methods of intramedullary fixation of fractures of the middle of the femoral shaft were evaluated in a sheep model to determine the effect of femoral reaming on pulmonary function. The effect of a modified reamer was also studied. A second experiment with the same model was performed to evaluate the relationship between embolization and pulmonary dysfunction. This experiment involved two groups of sheep—those with normal lungs and those with contused lungs—divided into subgroups—those that had nailing with reaming and those that had nailing without reaming. Intracardiac ultrasound was used to measure the magnitude and duration of transvenous particulate embolization during the operations. Both experiments involved hemodynamic monitoring during and after the nailing. The pulmonary tissue was examined histologically after the animals were killed.The hemodynamic monitoring revealed only a transient increase in pulmonary vascular resistance in the animals that had femoral nailing with reaming in both experiments. The modified reamer had no effect on the pulmonary response. Histological analysis of pulmonary tissue demonstrated a significant increase in the number of fat emboli in both the animals that had nailing with reaming and the animals that had nailing without reaming compared with the control animals. Intravascular ultrasound revealed that the operative maneuver associated with the greatest number of emboli was opening of the intramedullary canal with the awl. The first two passes of the reamer produced more emboli and embolism of longer duration than did the later passes. Pulmonary contusion did not increase the risk of pulmonary dysfunction due to intramedullary nailing in this model.CLINICAL RELEVANCE: Pulmonary dysfunction as a result of intramedullary nailing was minimum in our fracture model. There was no significant difference, between the animals that had reaming and those that did not have reaming, with regard to the adverse effects on pulmonary function. Reaming had a minor transient effect on pulmonary vascular resistance that was not seen in the animals that did not have reaming. The minor pulmonary effects in the two groups were not worsened by the presence of a pulmonary contusion. We concluded that, with regard to their effects on pulmonary function, there was no distinct advantage either to nailing with reaming or to nailing without reaming for fractures of the femoral shaft.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    12/04/2013
    New York - Icahn School of Medicine at Mount Sinai
    04/02/2014
    W. Virginia - Charleston Area Medical Center
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    02/28/2014
    District of Columbia (DC) - Children's National Medical Center