Early myocardial damage (EMD) and valvular dysfunction after femur fracture in pigs

Musculoskeletal injuries are the most common reason for surgery in severely injured patients. In addition to direct cardiac damage after physical trauma, there is rising evidence that trauma induces secondary cardiac structural and functional damage. Previous research associates hip fractures with the appearance of coronary heart disease: As 25% of elderly patients developed a major adverse cardiac event after hip fracture. 20 male pigs underwent femur fracture with operative stabilization via nailing (unreamed, reamed, RIA I and a new RIA II; each group n = 5). Blood samples were collected 6 h after trauma and the concentration of troponin I and heart-type fatty acid binding protein (HFABP) as biomarkers for EMD were measured. At baseline and 6 h after trauma, transesophageal ECHO (TOE) was performed; and invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after femur fracture. A systemic elevation of troponin I and HFABP indicate an early myocardial damage after femur fracture in pigs. Furthermore, various changes in systolic (ejection fraction and cardiac output) and diastolic (left ventricular end-diastolic pressure, mitral valve deceleration time and E/A ratio) parameters illustrate the functional impairment of the heart. These findings were accompanied by the development of valvular dysfunction (pulmonary and tricuspid valve). To the best of our knowledge, we described for the first time the development of functional impairment of the heart in the context of EMD after long bone fracture in pigs. Next to troponin and HFABP elevation, alterations in the systolic and diastolic function occurred and were accompanied by pulmonary and tricuspid valvular insufficiency. Regarding EMD, none of the fracture stabilization techniques (unreamed nailing, reaming, RIA I and RIA II) was superior.

PRIMARY UNREAMED NAILING IN GRADE I, II AND IIIA OPEN FRACTURES OF THE TIBIA SHAFT: A PROSPECTIVE STUDY OF THE OUTCOMES IN 80 PATIENTS

Introduction. To evaluate the incidences of union, nonunion and infection in the treatment of open tibial shaft fractures of Gustilo–Anderson types I, and IIIA treated with primary unreamed solid intramedullary locked nail (UTN). Materials and Methods. It is a prospective study of 80 open tibial shaft fractures. According to the AO classification, 36 patients (44%) were of type A, 29 (36%) were of type B and 15 (18%) were of type C. According to the Gustilo–Anderson classification, 31 patients (38.7%) were of grade I, 24 (30%) were of grade II and 25 (31%) were of grade IIIA. For the definitive stabilization of the fracture was used a UTN. Results. Bone healing was achieved in 98.4% of the cases, with a mean time of 24.2 weeks, ranging from 14 weeks to 110 weeks. Union without infection was seen in 70 patients (87%) and nonunion was seen in five patients (6%). Deep infection was seen in three patients (3.7%) and malunion was seen in two patients (2.5%). Conclusion. The treatment of open tibial shaft fractures with unreamed solid intramedullary locked nail allows high rates of bone healing and low rates of nonunion and deep infection, and if the presence of infection is excluded, then the results of unreamed nailing and reamed nailing are the same.