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Early local microcirculation is improved after intramedullary nailing in comparison to external fixation in a porcine model with a femur fracture

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

The local circulatory changes induced by intramedullary reaming are not fully understood. This study aimed to analyse the short-term local microcirculation associated with different surgical strategies in a porcine model with a mid-shaft fracture.

Methods

German landrace pigs were subjected to a standardised femoral fracture under standard anaesthesia and intensive care monitoring. One group was subjected to intramedullary reaming and nailing (nail group), while a second group was stabilised with external fixation (fix ex group). Microcirculation [e.g. relative blood flow (flow), oxygen saturation and relative haemoglobin concentration] was measured in the vastus lateralis muscle adjacent to the fracture using an O2C (oxygen to see, LEA Medizintechnik GMBH) device at 0 (before fracture, baseline), 6 (90-min posttreatment), 24, 48 and 72 h.

Results

A total of 24 male pigs were used (nail group, n = 12; fix ex group, n = 12). During the observation period, a significant increase of flow was found at 6 (P = 0.048), 48 (P = 0.023) and 72 h (P = 0.042) in comparison with baseline levels. Local oxygen delivery was significantly higher at 48 (P = 0.017) and 72 h (P = 0.021) in animals in the nail group compared to animals in the external fixation group.

Conclusion

This study used a standardised porcine femoral fracture model and determined a significant increase in local blood microcirculation (e.g. flow and oxygen delivery) in animals treated with intramedullary reaming compared to external fixation. These changes may be of importance for fracture healing and local and systemic inflammatory responses. Further studies in this area are justified.

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Acknowledgements

TREAT Research Group: B. Auner, Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. P. Stormann, Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. B. Relja, Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. I. Marzi, Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Frankfurt, Goethe University, Frankfurt/Main, Germany. T.-P. Simon, Department of Intensive Care and Intermediate Care, RWTH Aachen University, Germany. G. Marx, Department of Intensive Care and Intermediate Care, RWTH Aachen University, Germany. A. Haug, Department of Trauma Surgery, Technical University Munich, Germany. L. Egerer, Department of Trauma Surgery, Technical University Munich, Germany. M. V. Griensven, Department of Trauma Surgery, Technical University Munich, Germany. M. Kalbitz, Department of Orthopaedic Trauma, Hand-, Plastic-, and Reconstructive Surgery, University of Ulm, Germany. M. Huber-Lang, Department of Orthopaedic Trauma, Hand-, Plastic-, and Reconstructive Surgery, University of Ulm, Germany. R. Tolba, Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Germany. K. Reiss, Institute of Pharmacology and Toxicology, RWTH Aachen University, Germany. S. Uhlig, Institute of Pharmacology and Toxicology, RWTH Aachen University, Germany. K. Horst, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland. M. Teuben, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland. R. Pfeifer, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland. K. Almahmoud, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland. Y. Kalbas, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland. H. Luken, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland. K. Almahmoud, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland. F. Hildebrand, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland. H. C. Pape, Department of Orthopaedic Trauma, RWTH Aachen University, Germany; University Hospital Zurich, University of Zurich; Ramistr. 100, 8091 Zurich, Switzerland.

Funding

Project no. S-14-14P was supported by the AO Foundation. Zhi Qiao is supported by a scholarship from the Chinese Scholarship Council.

Author information

Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery, RWTH Aachen University Hospital Aachen, Aachen, Germany

    Zhi Qiao, Klemens Horst & Frank Hildebrand

  2. Department of Trauma Surgery and Harald-Tscherne Laboratory, University Hospital Zurich, University of Zurich, Ramistr. 100, 8091, Zurich, Switzerland

    Yannik Kalbas, Michel Teuben, Hans-Christoph Pape & Roman Pfeifer

  3. Institute for Laboratory Animal Science and Experimental Surgery, RWTH Aachen University, Aachen, Germany

    René H. Tolba

Authors
  1. Yannik Kalbas
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  2. Zhi Qiao
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  3. Klemens Horst
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  4. Michel Teuben
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  5. René H. Tolba
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  6. Frank Hildebrand
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  7. Hans-Christoph Pape
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  8. Roman Pfeifer
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Consortia

TREAT Research Group

  • B. Auner
  • , P. Stormann
  • , B. Relja
  • , I. Marzi
  • , T.-P. Simon
  • , G. Marx
  • , A. Haug
  • , L. Egerer
  • , M. V. Griensven
  • , M. Kalbitz
  • , M. Huber-Lang
  • , R. Tolba
  • , K. Reiss
  • , S. Uhlig
  • , K. Horst
  • , M. Teuben
  • , R. Pfeifer
  • , K. Almahmoud
  • , Y. Kalbas
  • , H. Luken
  • , K. Almahmoud
  • , F. Hildebrand
  •  & H. C. Pape

Corresponding author

Correspondence to Roman Pfeifer.

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Conflict of interest

There are no other conflicts of interest.

Research involving human participants and/or animals

Animals were involved in these experiments: the experiments were approved by the local authority (“Landesamt für Natur, Umwelt und Verbraucherschutz”: LANUV-NRW, Germany, AZ TV-Nr. 84-02.04.2014.A265).

Informed consent

All authors have read this manuscript and agreed for publication.

Additional information

This study performed within the consortium of the TREAT Research Group is listed in the Acknowledgements section.

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Kalbas, Y., Qiao, Z., Horst, K. et al. Early local microcirculation is improved after intramedullary nailing in comparison to external fixation in a porcine model with a femur fracture. Eur J Trauma Emerg Surg 44, 689–696 (2018). https://doi.org/10.1007/s00068-018-0991-y

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  • DOI: https://doi.org/10.1007/s00068-018-0991-y

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