Difference in influences of between reamed and unreamed intramedullary femoral nailing on lung function

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Objective: Pulmonary complicate after intramedullary nailing have been focused by many surgeons. We investigated whether the pulmonary function and the coagulatory response after reamed or unreamed intramedullary femoral nailing in normal lung status of sheep is altered Materials and Methods: A total of 15 adult sheeps were used. This experiment involved three groups (each, n=5) of sheep: reamed femoral nailing (RFN) groups, unreamed femoral nailing (UFN) group, and sham operation control (SOC) group. All experiments involved hemodynamic monitoring, blood gas analysis, and biochemical sampling (ATIII, LPO, triglyceride, fiblinogen during and 0 to 6 hours after the nailing. Bronchoalveolar lavage fluid (BALF) in each animal was analyzed 6 hours after nailing. Myeloperoxidase (MPO) activity in the pulmonary tissue was also examined after BAL. Results: There were no significant differences in both the time courses of hemodynamic monitoring data including pulmonary vascular resistance, systemic vascular resistance, and AaDO2, and those of biochemical data among three groups. In BALF analysis the leukocyte cell counts of RFN and UFN groups were higher than that of SOC group, and the lipid-laden cells of RFN group was higher than those of UFN and SOC groups. The MPO activity in puImonary tissue of RFN group was the highest, compared to those of the other two groups. Conclusion: RFN m normal lung status does not influence on pulmonary function in physiological level, and does not induce hyper-coagulatory response, at acute stage. However, RFN could be detrimental to lung in subclinical level on the basis of both the BALF results and the MPO assay results.