Limb reperfusion after
tourniquet ischemia causes pulmonary microvascular injury. Similarly, microembolization, like that associated with reamed femoral nailing, can induce pulmonary microvascular injury. Both processes result in increased pulmonary capillary membrane permeability and
edema. However, the association between femoral nailing followed by
tourniquet ischemia and clinical
lung injury has not been described. The authors reviewed 72 patients with femoral shaft fractures and tibial or
ankle fractures requiring internal fixation between 1987 and 1993. All femoral shaft fractures were treated with reamed intramedullary nails. Patients were divided into groups, based on whether the tibial or
ankle injury was managed surgically with (Group
T, 34 patients) or without (Group NT, 38 patients) a
tourniquet. Group T was subdivided based on
tourniquet time: T1, less than or equal to 90 minutes; T2, greater than 90 minutes. Groups were matched for injury severity. Group NT had fewer
ventilator dependent days and
intensive care days than Group T (NT:
ventilator dependent days, 2.5 +/- 5.2;
intensive care days, 3.9 +/- 6.5; T: 5.1 +/- 6.4;
intensive care days, 6.7 +/- 6.6).
Ventilator dependent days and
intensive care days increased with increasing
tourniquet time (T1:
ventilator dependent days, 3.2 +/- 3.6;
intensive care days, 5.4 +/- 4.6; T2:
ventilator dependent days, 7.5 +/- 8.5;
intensive care days, 8.5 +/- 8.5), suggesting that in patients with multitrauma, combining reamed femoral nailing with
fracture fixation under
tourniquet control increases pulmonary morbidity. Further investigation to measure
pulmonary injury associated with
ischemia reperfusion and
intramedullary nailing in patients with multitrauma is warranted.