Surgery pp 505-520 | Cite as

Trauma to the Pelvis and Extremities

  • Dean G. Lorich
  • Michael J. Gardner
  • David L. Helfet


Pelvic fractures account for 3% to 8% of all skeletal injuries.1, 2, 3 Two distinct patient populations sustain pelvic fractures: those involved in high-energy trauma, frequently motor vehicle or pedestrian versus motor vehicle collisions, and those who sustain a low-energy event, commonly an elderly patient with osteoporosis who sustains a fall resulting in a pelvic fracture with a stable pelvic ring and minimal concomitant injuries. High-energy mechanisms are involved in 13 % to 18 % of all pelvic fractures1,4 and are often accompanied by bony pelvic instability and severe soft tissue injuries, both locally and in remote systems. Injuries to the genitourinary and gastrointestinal system as a direct result of a pelvic fracture are frequent.5, 6, 7 Despite advances in organized trauma systems and intensive care, these fractures continue to present treatment dilemmas acutely and are a major source of morbidity and of mortality, which ranges from 7% to 50%.4,5,8, 9, 10, 11, 12, 13 Appropriate assessment and management by a multidisciplinary team are crucial to maximize the chance of survival of these patients and their return to preinjury function.


Femoral Fracture Injury Severity Score External Fixation Intramedullary Nailing Pelvic Fracture 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wolinsky PR. Assessment and management of pelvic fracture in the hemodynamically unstable patient. Orthop Clin N Am 1997;28:321–329.CrossRefGoogle Scholar
  2. 2.
    Gansslen A, Pohlemann T, Paul C, et al. Epidemiology of pelvic ring injuries. Injury 1996;27(suppl 1):S-A13–S-A20.Google Scholar
  3. 3.
    Giannoudis PV, Pape HC. Damage control orthopaedics in unstable pelvic ring injuries. Injury 2004;35:671–677.PubMedCrossRefGoogle Scholar
  4. 4.
    Pohlemann T, Bosch U, Gansslen A, Tscherne H. The Hannover experience in management of pelvic fractures. Clin Orthop 1994;305:69–80.PubMedGoogle Scholar
  5. 5.
    Demetriades D, Karaiskakis M, Toutouzas K, et al. Pelvic fractures: epidemiology and predictors of associated abdominal injuries and outcomes. J Am Coll Surg 2002;195:1–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Taffet R. Management of pelvic fractures with concomitant urologic injuries. Orthop Clin N Am 1997;28:389–396.CrossRefGoogle Scholar
  7. 7.
    Brandes S, Borrelli J Jr. Pelvic fracture and associated urologic injuries. World J Surg 2001;25:1578–1587.PubMedCrossRefGoogle Scholar
  8. 8.
    Allen CF, Goslar PW, Barry M, Christiansen T. Management guidelines for hypotensive pelvic fracture patients. Am Surg 2000;66:735–738.PubMedGoogle Scholar
  9. 9.
    Riemer BL, Butterfield SL, Diamond DL, et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma 1993;35:671–675; discussion 676–677.PubMedCrossRefGoogle Scholar
  10. 10.
    Rittmeister M, Lindsey RW, Kohl HW III. Pelvic fracture among polytrauma decedents. Trauma-based mortality with pelvic fracture: a case series of 74 patients. Arch Orthop Trauma Surg 2001;121:43–49.PubMedCrossRefGoogle Scholar
  11. 11.
    Burgess AR, Eastridge BJ, Young JW, et al. Pelvic ring disruptions: effective classification system and treatment protocols. J Trauma 1990;30:848–856.PubMedCrossRefGoogle Scholar
  12. 12.
    Eastridge BJ, Burgess AR. Pedestrian pelvic fractures: 5-year experience of a major urban trauma center. J Trauma 1997;42:695–700.PubMedCrossRefGoogle Scholar
  13. 13.
    Naam NH, Brown WH, Hurd R, et al. Major pelvic fractures. Arch Surg 1983;118:610–616.PubMedGoogle Scholar
  14. 14.
    Olson SA, Pollak AN. Assessment of pelvic ring stability after injury. Indications for surgical stabilization. Clin Orthop 1996;329:15–27.PubMedCrossRefGoogle Scholar
  15. 15.
    Kellam JF, McMurtry RY, Paley D, Tile M. The unstable pelvic fracture. Operative treatment. Orthop Clin N Am 1987;18:25–41.Google Scholar
  16. 16.
    Tile M. Pelvic ring fractures: should they be fixed? J Bone Joint Surg Br 1988;70:1–12.PubMedGoogle Scholar
  17. 17.
    Stocks GW, Gabel GT, Noble PC, et al. Anterior and posterior internal fixation of vertical shear fractures of the pelvis. J Orthop Res 1991;9:237–245.PubMedCrossRefGoogle Scholar
  18. 18.
    Dalai SA, Burgess AR, Siegel JH, et al. Pelvic fracture in multiple trauma: classification by mechanism is key to pattern of organ injury, resuscitative requirements, and outcome. J Trauma 1989;29:981–1000; discussion 1000–1002.Google Scholar
  19. 19.
    Cryer HM, Miller FB, Evers BM, et al. Pelvic fracture classification: correlation with hemorrhage. J Trauma 1988;28:973–980.PubMedGoogle Scholar
  20. 20.
    Hamill J, Holden A, Paice R, Civil I. Pelvic fracture pattern predicts pelvic arterial haemorrhage. Aust N Z J Surg 2000;70:338–343.PubMedCrossRefGoogle Scholar
  21. 21.
    Ghanayem AJ, Wilber JH, Lieberman JM, Motta AO. The effect of laparotomy and external fixator stabilization on pelvic volume in an unstable pelvic injury. J Trauma 1995;38:396–400;discussion 400–401.PubMedCrossRefGoogle Scholar
  22. 22.
    Latenser BA, Gentilello LM, Tarver AA, et al. Improved outcome with early fixation of skeletally unstable pelvic fractures. J Trauma 1991;31:28–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Ertel WK. General assessment and management of the polytrauma patient. In: Tile M, Helfet DL, Kellam JK, eds. Fractures of the Pelvis and Acetabulum. Philadelphia: Lippincott Williams & Wilkins, 2003.Google Scholar
  24. 24.
    Young JW, Burgess AR, Brumback RJ, Poka A. Pelvic fractures: value of plain radiography in early assessment and management. Radiology 1986;160:445–451.PubMedGoogle Scholar
  25. 25.
    Biffl WL, Smith WR, Moore EE, et al. Evolution of a multidisciplinary clinical pathway for the management of unstable patients with pelvic fractures. Ann Surg 2001;233:843–850.PubMedCrossRefGoogle Scholar
  26. 26.
    Moreno C, Moore EE, Rosenberger A, Cleveland HC. Hemorrhage associated with major pelvic fracture: a multispecialty challenge. J Trauma 1986;26:987–994.PubMedGoogle Scholar
  27. 27.
    Tscherne H, Pohlemann T, Gansslen A, et al. Crush injuries of the pelvis. Eur J Surg 2000;166:276–282.PubMedCrossRefGoogle Scholar
  28. 28.
    Evers BM, Cryer HM, Miller FB. Pelvic fracture hemorrhage. Priorities in management. Arch Surg 1989;124:422–424.PubMedGoogle Scholar
  29. 29.
    Blackmore CC, Jurkovich GJ, Linnau KF, et al. Assessment of volume of hemorrhage and outcome from pelvic fracture. Arch Surg 2003;138:504–508; discussion 508–509.PubMedCrossRefGoogle Scholar
  30. 30.
    Ganz R, Krushell RJ, Jakob RP, Kuffer J. The antishock pelvic clamp. Clin Orthop 1991;267:71–78.PubMedGoogle Scholar
  31. 31.
    Flint L, Babikian G, Anders M, et al. Definitive control of mortality from severe pelvic fracture. Ann Surg 1990;211:703–706; discussion 706–907.PubMedCrossRefGoogle Scholar
  32. 32.
    Failinger MS, McGanity PL. Unstable fractures of the pelvic ring. J Bone Joint Surg Am 1992;74:781–791.PubMedGoogle Scholar
  33. 33.
    Huittinen VM, Slatis P. Postmortem angiography and dissection of the hypogastric artery in pelvic fractures. Surgery (St. Louis) 1973;73:454–462.PubMedGoogle Scholar
  34. 34.
    Wong YC, Wang LJ, Ng CJ, et al. Mortality after successful transcatheter arterial embolization in patients with unstable pelvic fractures: rate of blood transfusion as a predictive factor. J Trauma 2000;49:71–75.PubMedCrossRefGoogle Scholar
  35. 35.
    Agnew SG. Hemodynamically unstable pelvic fractures. Orthop Clin N Am 1994;25:715–721.Google Scholar
  36. 36.
    Agolini SF, Shah K, Jaffe J, et al. Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 1997;43:395–399.PubMedCrossRefGoogle Scholar
  37. 37.
    Stephen DJ, Kreder HJ, Day AC, et al. Early detection of arterial bleeding in acute pelvic trauma. J Trauma 1999,47:638–642.Google Scholar
  38. 38.
    Shanmuganathan K, Mirvis SE, Sover ER. Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma. AJR Am J Roentgenol 1993;161:65–69.PubMedGoogle Scholar
  39. 39.
    Cerva DS Jr, Mirvis SE, Shanmuganathan K, et al. Detection of bleeding in patients with major pelvic fractures: value of contrast-enhanced CT. AJR Am J Roentgenol 1996;166:131–135.PubMedGoogle Scholar
  40. 40.
    Pereira SJ, O’Brien DP, Luchette FA, et al. Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture. Surgery (St. Louis) 2000;128:678–685.PubMedCrossRefGoogle Scholar
  41. 41.
    Moore FA, Moore EE. Evolving concepts in the pathogenesis of postinjury multiple organ failure. Surg Clin N Am 1995;75:257–277.PubMedGoogle Scholar
  42. 42.
    Rotondo MF, Schwab CW, McGonigal MD, et al. “Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993;35:375–382; discussion 382–383.PubMedCrossRefGoogle Scholar
  43. 43.
    Waydhas C, Nast-Kolb D, Trupka A, et al. Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. J Trauma 1996;40:624–630;discussion 630–631.PubMedCrossRefGoogle Scholar
  44. 44.
    Flint LM Jr, Brown A, Richardson JD, Polk HC. Definitive control of bleeding from severe pelvic fractures. Ann Surg 1979;189:709–716.PubMedCrossRefGoogle Scholar
  45. 45.
    Dickinson K, Roberts I. Medical anti-shock trousers (pneumatic anti-shock garments) for circulatory support in patients with trauma (Cochrane Review). Cochrane Database Syst Rev 2004;2: CD001856.Google Scholar
  46. 46.
    Mattox KL, Bickell W, Pepe PE, et al. Prospective MAST study in 911 patients. J Trauma 1989;29:1104–1111; discussion 1111–1112.PubMedCrossRefGoogle Scholar
  47. 47.
    Kregor PJ, Routt ML Jr. Unstable pelvic ring disruptions in unstable patients. Injury 1999;30(suppl 2):B19–B28.PubMedCrossRefGoogle Scholar
  48. 48.
    Routt ML Jr, Falicov A, Woodhouse E, Schildhauer TA. Circumferential pelvic antishock sheeting: a temporary resuscitation aid. J Orthop Trauma 2002;16:45–48.PubMedCrossRefGoogle Scholar
  49. 49.
    Simpson T, Krieg JC, Heuer F, Bottlang M. Stabilization of pelvic ring disruptions with a circumferential sheet. J Trauma 2002;52:158–161.PubMedCrossRefGoogle Scholar
  50. 50.
    Bottlang M, Simpson T, Sigg J, et al. Noninvasive reduction of open-book pelvic fractures by circumferential compression. J Orthop Trauma 2002;16:367–373.PubMedCrossRefGoogle Scholar
  51. 51.
    Ertel W, Keel M, Eid K, et al. Control of severe hemorrhage using C-clamp and pelvic packing in multiply injured patients with pelvic ring disruption. J Orthop Trauma 2001;15:468–474.PubMedCrossRefGoogle Scholar
  52. 52.
    Grimm MR, Vrahas MS, Thomas KA. Pressure-volume characteristics of the intact and disrupted pelvic retroperitoneum. J Trauma 1998,44:454–459.Google Scholar
  53. 53.
    Ben-Menachem Y, Coldwell DM, et al. Hemorrhage associated with pelvic fractures: causes, diagnosis, and emergent management. AJR Am J Roentgenol 1991;157:1005–1014.PubMedGoogle Scholar
  54. 54.
    Kimbrell BJ, Velmahos GC, Chan LS, Demetriades D. Angiographic embolization for pelvic fractures in older patients. Arch Surg 2004;139:728–732.PubMedCrossRefGoogle Scholar
  55. 55.
    Cook RE, Keating JF, Gillespie I. The role of angiography in the management of haemorrhage from major fractures of the pelvis. J Bone Joint Surg (Br) 2002;84:178–182.CrossRefGoogle Scholar
  56. 56.
    Velmahos GC, Toutouzas KG, Vassiliu P, et al. A prospective study on the safety and efficacy of angiographic embolization for pelvic and visceral injuries. J Trauma 2002;53:303–308.PubMedCrossRefGoogle Scholar
  57. 57.
    Perez JV, Hughes TM, Bowers K. Angiographic embolisation in pelvic fracture. Injury 1998;29:187–191.PubMedCrossRefGoogle Scholar
  58. 58.
    Mucha P Jr, Welch TJ. Hemorrhage in major pelvic fractures. Surg Clin N Am 1988;68:757–773.PubMedGoogle Scholar
  59. 59.
    Mucha P Jr, Farnell MB. Analysis of pelvic fracture management. J Trauma 1984;24:379–386.PubMedCrossRefGoogle Scholar
  60. 60.
    Johnson KD, Cadambi A, Seibert GB. Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures.J Trauma 1985;25:375–384.PubMedCrossRefGoogle Scholar
  61. 61.
    Goris RJ, Gimbrere JS, van Niekerk JL, et al. Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 1982;22:895–903.PubMedCrossRefGoogle Scholar
  62. 62.
    Seibel R, LaDuca J, Hassett JM, et al. Blunt multiple trauma (ISS 36), femur traction, and the pulmonary failure-septic state. Ann Surg 1985;202:283–295.PubMedCrossRefGoogle Scholar
  63. 63.
    Riska EB, Myllynen P. Fat embolism in patients with multiple injuries. J Trauma 1982;22:891–894.PubMedCrossRefGoogle Scholar
  64. 64.
    Riska EB, von Bonsdorff H, Hakkinen S, et al. Prevention of fat embolism by early internal fixation of fractures in patients with multiple injuries. Injury 1976;8:110–116.PubMedCrossRefGoogle Scholar
  65. 65.
    Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am 1989;71:336–340.PubMedGoogle Scholar
  66. 66.
    Bone LB, McNamara K, Shine B, Border J. Mortality in multiple trauma patients with fractures. J Trauma 1994;37:262–264; discussion 264–265.PubMedCrossRefGoogle Scholar
  67. 67.
    van Os JP, Roumen RM, Schoots FJ, et al. Is early osteosynthesis safe in multiple trauma patients with severe thoracic trauma and pulmonary contusion? J Trauma 1994;36:495–498.PubMedCrossRefGoogle Scholar
  68. 68.
    Charash WE, Fabian TC, Croce MA. Delayed surgical fixation of femur fractures is a risk factor for pulmonary failure independent of thoracic trauma. J Trauma 1994;37:667–672.PubMedCrossRefGoogle Scholar
  69. 69.
    Behrman SW, Fabian TC, Kudsk KA, Taylor JC. Improved outcome with femur fractures: early vs. delayed fixation. J Trauma 1990;30:792–797; discussion 797–798.PubMedCrossRefGoogle Scholar
  70. 70.
    Pape HC, Auf’m’Kolk M, Paffrath T, et al. Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion—a cause of posttraumatic ARDS? J Trauma 1993;34:540–547; discussion 547–548.PubMedCrossRefGoogle Scholar
  71. 71.
    Lozman J, Deno DC, Feustel PJ, et al. Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long-bone fractures. Arch Surg 1986;121:992–999.PubMedGoogle Scholar
  72. 72.
    Brundage SI, McGhan R, Jurkovich GJ, et al. Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries. J Trauma 2002;52:299–307.PubMedCrossRefGoogle Scholar
  73. 73.
    Pape HC, Grimme K, Van Griensven M, et al. Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: prospective randomized analysis by the EPOFF Study Group. J Trauma 2003;55:7–13.PubMedCrossRefGoogle Scholar
  74. 74.
    Reynolds MA, Richardson JD, Spain DA, et al. Is the timing of fracture fixation important for the patient with multiple trauma? Ann Surg 1995;222:470–478;discussion 478–481.PubMedCrossRefGoogle Scholar
  75. 75.
    Fakhry SM, Rutledge R, Dahners LE, Kessler D. Incidence, management, and outcome of femoral shaft fracture: a statewide population-based analysis of 2805 adult patients in a rural state. J Trauma 1994;37:255–260; discussion 260–261.PubMedCrossRefGoogle Scholar
  76. 76.
    Scalea TM, Boswell SA, Scott JD, et al. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma 2000;48:613–621; discussion 621–623.PubMedCrossRefGoogle Scholar
  77. 77.
    Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. J Bone Joint Surg Am 2000;82:781–788.PubMedCrossRefGoogle Scholar
  78. 78.
    Giannoudis PV, Abbott C, Stone M, et al. Fatal systemic inflammatory response syndrome following early bilateral femoral nailing. Intensive Care Med 1998;24:641–642.PubMedCrossRefGoogle Scholar
  79. 79.
    Giannoudis PV, Cohen A, Hinsche A, et al. Simultaneous bilateral femoral fractures: systemic complications in 14 cases. Int Orthop 2000;24:264–267.PubMedCrossRefGoogle Scholar
  80. 80.
    Smith RM, Giannoudis PV. Trauma and the immune response. J R Soc Med 1998;91:417–420.PubMedGoogle Scholar
  81. 81.
    Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg 2002;183:622–629.PubMedCrossRefGoogle Scholar
  82. 82.
    Pape HC, Hildebrand F, Pertschy S, et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma 2002;53:452–461; discussion 461–462.PubMedCrossRefGoogle Scholar
  83. 83.
    Levy D. The fat embolism syndrome. A review. Clin Orthop 1990:281–286.Google Scholar
  84. 84.
    Hulman G. The pathogenesis of fat embolism. J Pathol 1995;176:3–9.PubMedCrossRefGoogle Scholar
  85. 85.
    Robinson CM. Current concepts of respiratory insufficiency syndromes after fracture. J Bone Joint Surg Br 2001;83:781–791.PubMedCrossRefGoogle Scholar
  86. 86.
    Hauser CJ, Zhou X, Joshi P, et al. The immune microenvironment of human fracture/soft-tissue hematomas and its relationship to systemic immunity. J Trauma 1997;42:895–903; discussion 903–904.PubMedCrossRefGoogle Scholar
  87. 87.
    Perl M, Gebhard F, Knoferl MW, et al. The pattern of preformed cytokines in tissues frequently affected by blunt trauma. Shock 2003;19:299–304.PubMedCrossRefGoogle Scholar
  88. 88.
    Eppihimer MJ, Granger DN. Ischemia/reperfusion-induced leukocyte-endothelial interactions in postcapillary venules. Shock 1997;8:16–25.PubMedCrossRefGoogle Scholar
  89. 89.
    Bhandari M, Guyatt GH, Khera V, et al. Operative management of lower extremity fractures in patients with head injuries. Clin Orthop 2003;407:187–198.PubMedCrossRefGoogle Scholar
  90. 90.
    Winquist RA, Hansen ST, Jr., Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 1984;66:529–539.PubMedGoogle Scholar
  91. 91.
    Wenda K, Runkel M, Degreif J, Ritter G. Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing—demonstrated by intraoperative echocardiography. Injury 1993;24(suppl 3):S73–S81.PubMedCrossRefGoogle Scholar
  92. 92.
    Giannoudis PV, Smith RM, Bellamy MC, et al. Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures. An analysis of the second hit. J Bone Joint Surg Br 1999;81:356–361.PubMedCrossRefGoogle Scholar
  93. 93.
    Robinson CM, Ludlam CA, Ray DC, et al. The coagulative and cardiorespiratory responses to reamed intramedullary nailing of isolated fractures. J Bone Joint Surg Br 2001;83:963–973.PubMedCrossRefGoogle Scholar
  94. 94.
    Strecker W, Gonschorek O, Fleischmann W, et al. Thromboxane: co-factor of pulmonary disturbances in intramedullary nailing. Injury 1993;24(suppl 3):S68–S72.PubMedCrossRefGoogle Scholar
  95. 95.
    Pape HC, Bartels M, Pohlemann T, et al. Coagulatory response after femoral instrumentation after severe trauma in sheep. J Trauma 1998,45:720–728.Google Scholar
  96. 96.
    Christie J, Robinson CM, Pell AC, et al. Transcardiac echocardiography during invasive intramedullary procedures. J Bone Joint Surg Br 1995;77:450–455.PubMedGoogle Scholar
  97. 97.
    Saldeen T. Intravascular coagulation in the lungs in experimental fat embolism. Acta Chir Scand 1969;135:653–662.PubMedGoogle Scholar
  98. 98.
    Wozasek GE, Thurnher M, Redl H, Schlag G. Pulmonary reaction during intramedullary fracture management in traumatic shock: an experimental study. J Trauma 1994;37:249–254.PubMedCrossRefGoogle Scholar
  99. 99.
    Barie PS, Minnear FL, Malik AB. Increased pulmonary vascular permeability after bone marrow injection in sheep. Am Rev Respir Dis 1981;123:648–653.PubMedGoogle Scholar
  100. 100.
    Gossling HR, Pellegrini VD Jr. Fat embolism syndrome: a review of the pathophysiology and physiological basis of treatment. Clin Orthop 1982;165:68–82.PubMedGoogle Scholar
  101. 101.
    Pape HC, Giannoudis PV, Grimme K, et al. Effects of intramedullary femoral fracture fixation: what is the impact of experimental studies in regards to the clinical knowledge? Shock 2002;18:291–300.PubMedCrossRefGoogle Scholar
  102. 102.
    Giannoudis PV, Pape HC, Cohen AP, et al. Review: systemic effects of femoral nailing: from Kuntscher to the immune reactivity era. Clin Orthop Relat Res 2002;404:378–386.PubMedCrossRefGoogle Scholar
  103. 103.
    Kropfl A, Berger U, Neureiter H, et al. Intramedullary pressure and bone marrow fat intravasation in unreamed femoral nailing. J Trauma 1997;42:946–954.PubMedCrossRefGoogle Scholar
  104. 104.
    Schemitsch EH, Jain R, Turchin DC, et al. Pulmonary effects of fixation of a fracture with a plate compared with intramedullary nailing. A canine model of fat embolism and fracture fixation. J Bone Joint Surg Am 1997;79:984–996.PubMedGoogle Scholar
  105. 105.
    Aoki N, Soma K, Shindo M, et al. Evaluation of potential fat emboli during placement of intramedullary nails after orthopedic fractures. Chest 1998;113:178–181.PubMedCrossRefGoogle Scholar
  106. 106.
    Pell AC, Christie J, Keating JF, Sutherland GR. The detection of fat embolism by transoesophageal echocardiography during reamed intramedullary nailing. A study of 24 patients with femoral and tibial fractures. J Bone Joint Surg Br 1993;75:921–925.PubMedGoogle Scholar
  107. 107.
    Duwelius PJ, Huckfeldt R, Mullins RJ, et al. The effects of femoral intramedullary reaming on pulmonary function in a sheep lung model. J Bone Joint Surg Am 1997;79:194–202.PubMedGoogle Scholar
  108. 108.
    Willis BH, Carden DL, Sadasivan KK. Effect of femoral fracture and intramedullary fixation on lung capillary leak. J Trauma 1999,46:687–692.Google Scholar
  109. 109.
    Norris BL, Patton WC, Rudd JN Jr, et al. Pulmonary dysfunction in patients with femoral shaft fracture treated with intramedullary nailing. J Bone Joint Surg Am 2001;83A:1162–1168.Google Scholar
  110. 110.
    Smith RM, Giannoudis PV, Bellamy MC, et al. Interleukin-10 release and monocyte human leukocyte antigen-DR expression during femoral nailing. Clin Orthop 2000;16:233–240.Google Scholar
  111. 111.
    Giannoudis PV, Hildebrand F, Pape HC. Inflammatory serum markers in patients with multiple trauma. Can they predict outcome? J Bone Joint Surg Br 2004;86:313–323.PubMedCrossRefGoogle Scholar
  112. 112.
    Roumen RM, Redl H, Schlag G, et al. Inflammatory mediators in relation to the development of multiple organ failure in patients after severe blunt trauma. Crit Care Med 1995;23:474–480.PubMedCrossRefGoogle Scholar
  113. 113.
    Riche F, Panis Y, Laisne MJ, et al. High tumor necrosis factor serum level is associated with increased survival in patients with abdominal septic shock: a prospective study in 59 patients. Surgery (St. Louis) 1996;120:801–807.PubMedCrossRefGoogle Scholar
  114. 114.
    Casey LC, Balk RA, Bone RC. Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 1993;119:771–778.PubMedGoogle Scholar
  115. 115.
    Pape HC, van Griensven M, Rice J, et al. Major secondary surgery in blunt trauma patients and perioperative cytokine liberation: determination of the clinical relevance of biochemical markers. J Trauma 2001;50:989–1000.PubMedCrossRefGoogle Scholar
  116. 116.
    Ogura H, Tanaka H, Koh T, et al. Priming, second-hit priming, and apoptosis in leukocytes from trauma patients. J Trauma 1999;46:774–781; discussion 781–783.PubMedCrossRefGoogle Scholar
  117. 117.
    Partrick DA, Moore FA, Moore EE, et al. Jack A. Barney Resident Research Award winner. The inflammatory profile of interleukin-6, interleukin-8, and soluble intercellular adhesion molecule-1 in postinjury multiple organ failure. Am J Surg 1996;172:425–429; discussed 429–431.PubMedCrossRefGoogle Scholar
  118. 118.
    Pape HC, Schmidt RE, Rice J, et al. Biochemical changes after trauma and skeletal surgery of the lower extremity: quantification of the operative burden. Crit Care Med 2000;28:3441–448.PubMedCrossRefGoogle Scholar
  119. 119.
    Pape HC, Remmers D, Grotz M, et al. Reticuloendothelial system activity and organ failure in patients with multiple injuries. Arch Surg 1999;134:421–427.PubMedCrossRefGoogle Scholar
  120. 120.
    Nast-Kolb D, Waydhas C, Jochum M, et al. [Is there a favorable time for the management of femoral shaft fractures in polytrauma?] Chirurg 1990;61:259–265.PubMedGoogle Scholar
  121. 121.
    Giannoudis PV. Surgical priorities in damage control in polytrauma. J Bone Joint Surg Br 2003;85:478–483.PubMedCrossRefGoogle Scholar
  122. 122.
    Pape H, Stalp M, von Griensven M, et al. [Optimal timing for secondary surgery in polytrauma patients: an evaluation of 4,314 serious-injury cases.] Chirurg 1999;70:1287–1293.PubMedCrossRefGoogle Scholar
  123. 123.
    Wozasek GE, Simon P, Redl H, Schlag G. Intramedullary pressure changes and fat intravasation during intramedullary nailing: an experimental study in sheep. J Trauma 1994;36:202–207.PubMedCrossRefGoogle Scholar
  124. 124.
    Pape HC, Regel G, Dwenger A, et al. Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma. J Trauma 1993;35:709–716.PubMedCrossRefGoogle Scholar
  125. 125.
    Talucci RC, Manning J, Lampard S, et al. Early intramedullary nailing of femoral shaft fractures: a cause of fat embolism syndrome. Am J Surg 1983;146:107–111.PubMedCrossRefGoogle Scholar
  126. 126.
    Bosse MJ, MacKenzie EJ, Riemer BL, et al. Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate. A comparative study. J Bone Joint Surg Am 1997;79:799–809.PubMedGoogle Scholar
  127. 127.
    Weresh MJ, Stover MD, Bosse MJ, et al. Pulmonary gas exchange during intramedullary fixation of femoral shaft fractures. J Trauma 1999;46:863–868.PubMedCrossRefGoogle Scholar
  128. 128.
    Bone LB, Babikian G, Stegemann PM. Femoral canal reaming in the polytrauma patient with chest injury. A clinical perspective. Clin Orthop 1995;347:91–94.Google Scholar
  129. 129.
    Boulanger BR, Stephen D, Brenneman FD. Thoracic trauma and early intramedullary nailing of femur fractures: are we doing harm? J Trauma 1997;43:24–28.PubMedCrossRefGoogle Scholar
  130. 130.
    Carlson DW, Rodman GH Jr, Kaehr D, et al. Femur fractures in chest-injured patients: is reaming contraindicated? J Orthop Trauma 1998;12:164–168.PubMedCrossRefGoogle Scholar
  131. 131.
    van der Made WJ, Smit EJ, van Luyt PA, van Vugt AB. Intramedullary femoral osteosynthesis: an additional cause of ARDS in multiply injured patients? Injury 1996;27:391–393.PubMedCrossRefGoogle Scholar
  132. 132.
    Grotz MR, Giannoudis PV, Pape HC, et al. Traumatic brain injury and stabilisation of long bone fractures: an update. Injury 2004;35:1077–1086.PubMedCrossRefGoogle Scholar
  133. 133.
    Kushwaha VP, Garland DG. Extremity fractures in the patient with a traumatic brain injury. J Am Acad Orthop Surg 1998;6:298–307.PubMedGoogle Scholar
  134. 134.
    Schmeling GJ, Schwab JP. Polytrauma care. The effect of head injuries and timing of skeletal fixation. Clin Orthop 1995;318:106–116.PubMedGoogle Scholar
  135. 135.
    Sarrafzadeh AS, Peltonen EE, Kaisers U, et al. Secondary insults in severe head injury: do multiply injured patients do worse? Crit Care Med 2001;29:1116–1123.PubMedCrossRefGoogle Scholar
  136. 136.
    Schoettle RJ, Kochanek PM, Magargee MJ, et al. Early polymorphonuclear leukocyte accumulation correlates with the development of posttraumatic cerebral edema in rats. J Neurotrauma 1990;7:207–217.PubMedCrossRefGoogle Scholar
  137. 137.
    Schmoker JD, Zhuang J, Shackford SR. Hemorrhagic hypotension after brain injury causes an early and sustained reduction in cerebral oxygen delivery despite normalization of systemic oxygen delivery. J Trauma 1992;32:714–720; discussion 721–722.PubMedCrossRefGoogle Scholar
  138. 138.
    Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma 1993;34:216–222.PubMedCrossRefGoogle Scholar
  139. 139.
    Pietropaoli JA, Rogers FB, Shackford SR, et al. The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries. J Trauma 1992;33:403–407.PubMedCrossRefGoogle Scholar
  140. 140.
    Wald SL, Shackford SR, Fenwick J. The effect of secondary insults on mortality and long-term disability after severe head injury in a rural region without a trauma system. J Trauma 1993;34:377–381; discussion 381–382.PubMedCrossRefGoogle Scholar
  141. 141.
    Chesnut RM. Secondary brain insults after head injury: clinical perspectives. New Horiz 1995;3:366–375.PubMedGoogle Scholar
  142. 142.
    Poole GV, Miller JD, Agnew SG, Griswold JA. Lower extremity fracture fixation in head-injured patients. J Trauma 1992;32:654–659.PubMedCrossRefGoogle Scholar
  143. 143.
    Starr AJ, Hunt JL, Chason DP, et al. Treatment of femur fracture with associated head injury. J Orthop Trauma 1998;12:38–45.PubMedCrossRefGoogle Scholar
  144. 144.
    Jaicks RR, Cohn SM, Moller BA. Early fracture fixation may be deleterious after head injury. J Trauma 1997;42:1–5; discussion 5–6.PubMedCrossRefGoogle Scholar
  145. 145.
    Martens F, Ectors P. Priorities in the management of polytraumatised patients with head injury: partially resolved problems. Acta Neurochir (Wien) 1988;94:70–73.CrossRefGoogle Scholar
  146. 146.
    Scalea TM, Scott JD, Brumback RJ, et al. Early fracture fixation may be “just fine” after head injury: no difference in central nervous system outcomes. J Trauma 1999;46:839–846.PubMedCrossRefGoogle Scholar
  147. 147.
    McKee MD, Schemitsch EH, Vincent LO, et al. The effect of a femoral fracture on concomitant closed head injury in patients with multiple injuries. J Trauma 1997;42:1041–1045.PubMedCrossRefGoogle Scholar
  148. 148.
    Kotwica Z, Balcewicz L, Jagodzinski Z. Head injuries coexistent with pelvic or lower extremity fractures early or delayed osteosynthesis. Acta Neurochir (Wien) 1990;102:19–21.CrossRefGoogle Scholar
  149. 149.
    Hofman PA, Goris RJ. Timing of osteosynthesis of major fractures in patients with severe brain injury. J Trauma 1991;31:261–263.PubMedCrossRefGoogle Scholar
  150. 150.
    Kalb DC, Ney AL, Rodriguez JL, et al. Assessment of the relationship between timing of fixation of the fracture and secondary brain injury in patients with multiple trauma. Surgery (St. Louis) 1998;124:739–744; discussion 744–745.PubMedCrossRefGoogle Scholar
  151. 151.
    Velmahos GC, Arroyo H, Ramicone E, et al. Timing of fracture fixation in blunt trauma patients with severe head injuries. Am J Surg 1998;176:324–329.PubMedCrossRefGoogle Scholar
  152. 152.
    Malisano LP, Stevens D, Hunter GA. The management of long bone fractures in the head-injured polytrauma patient. J Orthop Trauma 1994;8:1–5.PubMedCrossRefGoogle Scholar
  153. 153.
    Townsend RN, Lheureau T, Protech J, et al. Timing fracture repair in patients with severe brain injury (Glasgow Coma Scale score <9). J Trauma 1998;44:977–982; discussion 982–983.PubMedCrossRefGoogle Scholar
  154. 154.
    Nau T, Aldrian S, Koenig F, Vecsei V. Fixation of femoral fractures in multiple-injury patients with combined chest and head injuries. ANZ J Surg 2003;73:1018–1021.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Dean G. Lorich
    • 1
    • 2
  • Michael J. Gardner
    • 3
  • David L. Helfet
    • 1
    • 2
  1. 1.Department of Orthopedic Surgery, Weill Cornell Medical CenterHospital for Special Surgery/New York-Presbyterian HospitalNew YorkUSA
  2. 2.Orthopaedic Trauma ServiceHospital for Special Surgery/New York-Presbyterian HospitalNew YorkUSA
  3. 3.Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkUSA

Personalised recommendations