Influence of the timing of internal fixation of femur XXXX during shock resuscitation on remote organ damage.

@entity174 @entity548 @entity16 @entity95 @entity158
BACKGROUND: Reamed intramedullary nailing is the gold standard for management of femur @entity174 . Nailing within 24   h is proven to reduce complications from ongoing @entity548 , soft-tissue damage and @entity158 . However, when combined with @entity548 , femur @entity174 and intramedullary nailing are associated with immune-mediated damage to remote organs. We studied whether delaying @entity174 fixation until resuscitation was succeeding would lead to a significant @entity16 . METHODS: Twenty male @entity95 underwent closed femur @entity174 , @entity548 , resuscitation and either immediate nailing (group: ImmFix, n = 9), delayed nailing (group: DelFix, n = 8) or just splinting (group: NoFix, n = 3). @entity548 shock was maintained for 60   min. Resuscitation was with shed blood and Hartmann's solution. Animals were euthanized 8   h after fixation; the lungs and small bowel were scored histologically by two pathologists. RESULTS: Groups did not differ in weight, @entity548 volume or magnitude of shock. At 8   h, there was no difference in end-organ damage between ImmFix and DelFix groups (11.3    1.6 and 13.2    1.6 versus 8.1    1.3 and 12.9    1.1, P = 0.26 between groups). However, the NoFix group had significantly greater end-organ damage when compared with the fixation at any time groups (17.3    2.7 and 17.0    3.3 versus 9.8    1.1 and 13.1    1, P = 0.01 between groups). CONCLUSION: In this laboratory model, we have demonstrated that timely femur @entity174 fixation outweighs the potential harmful effects of surgery performed during @entity548 with simultaneous resuscitation. We have failed to demonstrate a difference between immediate and delayed fixation during resuscitation.
