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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 6, 823-827.
doi: 10.1302/0301-620X.88B6.17359  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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The early response to major trauma and intramedullary nailing

T. O. White, MD, FRCS(Trauma & Orth), Consultant Orthopaedic Trauma Surgeon1; R. E. Clutton, BVSc, MRCVS, MRCA, Senior Lecturer in Veterinary Anaesthesia2; D. Salter, MD, FRCPath, Reader in Pathology3; D. Swann, FRCA, Consultant Anaesthetist4; J. Christie, FRCS, Consultant Orthopaedic Trauma Surgeon1; and C. M. Robinson, FRCS(Trauma & Orth), Consultant Orthopaedic Trauma Surgeon1

1 Department of Orthopaedic and Trauma Surgery
2 Department of Veterinary Anaesthesia, Royal (Dick) School of Veterinary Medicine, University of Edinburgh, Summerhall, Edinburgh EH9 1QH, UK.
3 Department of Pathology
4 Department of Anaesthesia and Intensive Care, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4SU, UK.

Correspondence should be sent to Mr T. O. White; e-mail: twhite{at}rcsed.ac.uk

The stress response to trauma is the summation of the physiological response to the injury (the ‘first hit’) and by the response to any on-going physiological disturbance or subsequent trauma surgery (the ‘second hit’).

Our animal model was developed in order to allow the study of each of these components of the stress response to major trauma. High-energy, comminuted fracture of the long bones and severe soft-tissue injuries in this model resulted in a significant tropotropic (depressor) cardiovascular response, transcardiac embolism of medullary contents and activation of the coagulation system. Subsequent stabilisation of the fractures using intramedullary nails did not significantly exacerbate any of these responses.




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J. R. Morley, R. M. Smith, H. C. Pape, D. A. MacDonald, L. K. Trejdosiewitz, and P. V. Giannoudis
Stimulation of the local femoral inflammatory response to fracture and intramedullary reaming: A PRELIMINARY STUDY OF THE SOURCE OF THE SECOND HIT PHENOMENON
J Bone Joint Surg Br, March 1, 2008; 90-B(3): 393 - 399.
[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General