Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long-bone fractures
J. Lozman, D. C. Deno, P. J. Feustel, J. C. Newell, H. H. Stratton, N. Sedransk, R. Dutton, J. B. Fortune and D. M. Shah
We randomly assigned patients with multiple trauma who had tibial or
femoral fractures to one of two groups--one group received immediate
fixation of all fractures, and the second group received conservative
orthopedic management, consisting of traction or plaster casts. Studies
were conducted twice each day for four days following injury. Mean cardiac
index was 1.3 L/min/m2 higher and mean shunt was 5.2% lower in the
immediate fixation group compared with the group receiving conservative
treatment. Other pulmonary and systemic hemodynamic variables did not
differ between the groups. The incidence of fat macroglobules in blood
aspirated from the pulmonary capillaries was higher when compared with that
in pulmonary arterial blood but was not significantly different between the
two treatment groups. Platelet count was significantly lower and fibrinogen
concentration was significantly higher in the group receiving immediate
fixation. We found no diagnostic significance of the incidence of fat
macroglobules in samples of blood aspirated from the pulmonary circulation.
We conclude that patients receiving immediate fixation had less pulmonary
dysfunction following multiple trauma and long-bone fractures.
