E-ISSN 2367-699X | ISSN 2367-7414
 

Original Research 


Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa.

Abstract
Background: Currently, the most widely used technique of osteosynthesis in the treatment of proximal femur fractures is the intramedullary nailing and canal reaming. However, intramedullary canal reaming causes a significant release of IL-6 and an important systemic inflammatory reaction. A surgical variant technique is the introduction of the nail with no canal reaming in order to reduce the trauma produced, to simplify and speed up the process of osteosynthesis and, presumably, to reduce the systemic inflammatory response produced by the reaming procedure.The purpose of the study is the comparative evaluation between the reamed and unreamed surgical techniques in terms of increased biochemical markers of organ damage and inflammation.

Material and methods: The retrospective observational study was conducted between March 2014 and October 2015 on a sample of 199 patients. The following values were recorded: D-dimer, Troponin, alkaline phosphatase(ALP), ESR, CRP, LDH at admission, at 1st and 4th postoperative days, and the percentage change was calculated between the values of the fourth postoperative day, and those at admission. The Mann-Whitney test was administered for the significance of differences, with p-value<0.05.

Results: The statistical analysis showed a significant difference in the change of Troponin levels (p-value 0.049) and D-dimer (p-value <0.0001), while the change of alkaline phosphatase, LDH, CRP, ESR were not important (p-value respectively 0.40, 0.59, 0.97, 0.22).

Conclusions: Our study shows that the technique with no femoral canal reaming is associated with a modest increase of predictive index of cardio-respiratory complications such as Troponin and D-dimer.

Key words: Reaming; Non-Reaming; Nailing; Troponin; D-Dimer; Pertrochanteric Fractures


 
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Pubmed Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa. Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.. Int J Surg Med. 2017; 3(2): 96-102. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures


Web Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa. Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.. http://www.ejos.org/?mno=248002 [Access: January 18, 2019]. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures


AMA (American Medical Association) Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa. Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.. Int J Surg Med. 2017; 3(2): 96-102. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures



Vancouver/ICMJE Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa. Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.. Int J Surg Med. (2017), [cited January 18, 2019]; 3(2): 96-102. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures



Harvard Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa (2017) Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.. Int J Surg Med, 3 (2), 96-102. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures



Turabian Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa. 2017. Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.. International Journal of Surgery and Medicine, 3 (2), 96-102. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures



Chicago Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa. "Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.." International Journal of Surgery and Medicine 3 (2017), 96-102. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures



MLA (The Modern Language Association) Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa. "Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.." International Journal of Surgery and Medicine 3.2 (2017), 96-102. Print. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures



APA (American Psychological Association) Style

Michele Bisaccia, Fulvio Nisi, Giuseppe Rinonapoli, Eleonora Natali, Luigi Meccariello, Andrea Schiavone, Paolo Ceccarini, Olga Bisaccia, Auro Caraffa (2017) Reamed versus unreamed intramedullary nailing in the treatment of elderly pertrochanteric femoral fractures: evaluation of the systemic inflammatory response and organ dysfunction.. International Journal of Surgery and Medicine, 3 (2), 96-102. doi:10.5455/ijsm.treatment-of-elderly-pertrochanteric-femoral-fractures