Does the Reamer Type Influence the Degree of Lung Dysfunction After Femoral Nailing Following Severe Trauma? An Animal Study

In multiple trauma patients with lung contusion, pulmonary complications have been reported that were attributed to intramedullary stabilization of the femur. The reaming procedure of the medullary canal is thought to play a major role. We investigated whether different types of reamers might exert different amounts of fat mobilization into the vascular system and different degrees of pulmonary dysfunction. Adult female Merino sheep were submitted to hemorrhagic shock (2 h, 50 mm Hg) and a unilateral lung contusion; in addition, a lung lymph fistula was created. Pulmonary capillary permeability, central venous triglyceride levels, 11-dehydro-thromboxane B2 (dh- TXB2) levels, and pulmonary artery pressure were determined. After recovery, animals were randomly assigned to intramedullary femoral nailing using several types of reamersgroup A, AO reamer (n=8); group B, Biomet reamer (n=7); group H, Howmedica reamer (n=6); group C, controls, no reaming (n=4). Intramedullary reaming caused a significant (p