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Possible Cause of Hepatic Dysfunction

William J. Schirmer, MD; James M. Schirmer; Michael C. Townsend, MD; Donald E. Fry, MD

Arch Surg. 1988;123(4):412-415.

Abstract
• Clinical studies demonstrate that early débridement and operative fixation of femur fractures in multiply injured patients lowers both the incidence and severity of hepatic failure. Perhaps the single most important determinant of hepatic function is nutrient hepatic perfusion. This study compares systemic and hepatic blood flow in rats that have sustained femur fractures with or without associated soft-tissue injury. Femur fracture without soft-tissue trauma resulted in a hyperdynamic state with normal blood flow distribution at 24 hours after injury and normal hemodynamics at 48 hours. When femur fracture was associated with soft-tissue trauma, the elevated cardiac output at 24 hours was not matched by a proportionately elevated hepatic blood flow. In this latter group, the cardiac output was normal at 48 hours, but the hepatic perfusion defect remained. Retained fracture fragments, hematoma, and injured and necrotic soft tissue may serve as a stimulus leading to a pathologic reduction in hepatic perfusion.

(Arch Surg 1988;123:412-415)

Author Affiliations
From the Department of Surgery, Veterans' Administration Medical Center, Case Western Reserve University Hospitals, Cleveland. Drs Schirmer and Townsend are Dudley P. Allen Fellows in Surgical Research, Case Western Reserve University Hospitals.

Footnotes
Accepted for publication Nov 4, 1987.

Read before the Association of Veterans Administration Surgeons, Portland, Ore, May 9, 1987.

Reprint requests to Department of Surgery 112W, Veterans Administration Medical Center, 10701 East Blvd, Cleveland, OH 44106 (Dr Schirmer).

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