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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 3, 393-399.
doi: 10.1302/0301-620X.90B3.19688  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Stimulation of the local femoral inflammatory response to fracture and intramedullary reaming

A PRELIMINARY STUDY OF THE SOURCE OF THE SECOND HIT PHENOMENON

J. R. Morley, MD, FRCSEd, Lecturer in Orthopaedic Trauma Surgery1; R. M. Smith, MD, FRCS, Chief of Trauma Surgery2; H. C. Pape, MD, Chief of Orthopaedic Trauma Surgery3; D. A. MacDonald, MB, BS, FRCS, Consultant Orthopaedic Trauma Surgeon1; L. K. Trejdosiewitz, PhD, Reader in Immunology1; and P. V. Giannoudis, MD, EEC (Orth), Professor of Orthopaedic and Trauma Surgery1

1 Academic Department of Orthopaedic and Trauma Surgery, Leeds University, The General Infirmary at Leeds, Clarendon Wing, Great George Street, Leeds LS1 3EX, UK.
2 Orthopaedic Trauma Service Massachusetts General Hospital, YAW 3600, 55 Fruit Street, Boston, Massachusetts 02114, USA.
3 Division of Trauma University of Pittsburgh Medical Center, Pittsburgh 15213, USA.

Correspondence should be sent to Professor P. V. Giannoudis; e-mail: pgiannoudi{at}aol.com

We have undertaken a prospective study in patients with a fracture of the femoral shaft requiring intramedullary nailing to test the hypothesis that the femoral canal could be a potential source of the second hit phenomenon. We determined the local femoral intramedullary and peripheral release of interleukin-6 (IL-6) after fracture and subsequent intramedullary reaming.

In all patients, the fracture caused a significant increase in the local femoral concentrations of IL-6 compared to a femoral control group. The concentration of IL-6 in the local femoral environment was significantly higher than in the patients own matched blood samples from their peripheral circulation. The magnitude of the local femoral release of IL-6 after femoral fracture was independent of the injury severity score and whether the fracture was closed or open.

In patients who underwent intramedullary reaming of the femoral canal a further significant local release of IL-6 was demonstrated, providing evidence that intramedullary reaming can cause a significant local inflammatory reaction.






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