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The Effects of Surgical Fracture Fixation on the Systemic Inflammatory Response to Major Trauma

Dr. Pallister is Senior Lecturer in Trauma & Orthopaedics, Department of Trauma & Orthopaedics, Morriston Hospital, Morriston, Swansea, United Kingdom. Dr. Empson is Specialist Registrar in Accident & Emergency Medicine, Birmingham Children’s Hospital NHS Trust, Steel-house Lane, Birmingham, United Kingdom.

Reprint requests: Dr. Pallister, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea SA6 6NL, United Kingdom.

Early stabilization of major long bone fractures is beneficial in reducing the incidence of acute respiratory distress syndrome and multiple organ failure, both of which are caused by activation of the systemic inflammatory response. This activation results in tissue recruitment of and injury by circulating polymorphonuclear leukocytes. The reasons for clinical benefits of early fracture stabilization in major trauma are unknown. Published studies indicate that fracture surgery increases the post-traumatic inflammatory response. Major surgery to stabilize fractures carries a higher complication rate when performed on patients whose hypovolemic shock is not fully corrected. Thus, fracture care should be tailored to the patient, not dictated by the injured bone. Understanding the impact of fracture surgery on the systemic inflammatory response to major trauma is necessary to refine treatment and to apply it optimally to all patients.

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