Prospective RCT across 7 Level 1 trauma centers randomizing 315 multiply injured patients with femoral shaft fractures to reamed vs. unreamed intramedullary nailing, with primary outcome of ARDS incidence. All fractures were nailed within 24 hours of injury. Directly challenges the concern raised by Pape et al. that reamed nailing increases pulmonary morbidity in polytrauma.
When nailing a femoral shaft fracture in a polytrauma patient, this RCT supports that reamed nailing carries no clinically detectable increase in ARDS risk compared to unreamed — the Canadian Orthopaedic Trauma Society found no grounds to abandon reamed nailing as standard practice.
Keep in mind the trial was underpowered, so absence of evidence is not evidence of absence; in the highest-risk chest-injured patient, awareness of the molecular 'second hit' data (IL-6, elastase elevation with reaming) may still inform damage-control decision-making.
Prospective RCT across 7 Level 1 trauma centers randomizing 315 multiply injured patients with femoral shaft fractures to reamed vs. unreamed intramedullary nailing, with primary outcome of ARDS incidence. All fractures were nailed within 24 hours of injury. Directly challenges the concern raised by Pape et al. that reamed nailing increases pulmonary morbidity in polytrauma.
When nailing a femoral shaft fracture in a polytrauma patient, this RCT supports that reamed nailing carries no clinically detectable increase in ARDS risk compared to unreamed — the Canadian Orthopaedic Trauma Society found no grounds to abandon reamed nailing as standard practice.
Keep in mind the trial was underpowered, so absence of evidence is not evidence of absence; in the highest-risk chest-injured patient, awareness of the molecular 'second hit' data (IL-6, elastase elevation with reaming) may still inform damage-control decision-making.