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Jeffrey Lozman, MD; D. Curtis Deno, MD; Paul J. Feustel, PhD; Jonathan C. Newell, PhD; Howard H. Stratton, PhD; Nell Sedransk, PhD; Robert Dutton, MD; John B. Fortune, MD; Dhiraj M. Shah, MD, FACS

Arch Surg. 1986;121(9):992-999.

Abstract
• 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.

(Arch Surg 1986;121:992-999)

Author Affiliations
From the Samuel R. Powers, Jr, Trauma Research Center; the Departments of Surgery and Physiology, Albany (NY) Medical Center (Drs Lozman, Deno, Feustel, Dutton, Fortune, and Shah); the Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY (Dr Newell); and the Department of Mathematics and Statistics, State University of New York, Albany (Drs Stratton and Sedransk).

Footnotes
Accepted for publication April 2, 1986.

Reprint requests to the Department of Surgery, Albany Medical College, Albany, NY 12208 (Dr Shah).

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