Influence of thoracic trauma and primary femoral intramedullary nailing on the incidence of ARDS in multiple trauma patients

In multiple trauma patients the development of pulmonary complications (pneumonia, posttraumatic adult respiratory distress syndrome (ARDS)) represents a major problem and can have a substantial impact on the duration of intensive care treatment as well as on outcome. An association between the timing of stabilisation of long bone fractures and the incidence of pulmonary complications has been discussed. In several studies, primary fracture stabilisation of femoral shaft fractures, preferably by intramedullary stabilisation (Lhowe and Hansen, 1988), was shown to reduce the incidence of pneumonia and ARDS and was therefore advocated (Goris et al., 1982; Tscherne, 1983; Kwasni et al., 1986; Ruedi and Wolff, 1975; Bone et al., 1989; Johnson et al., 1985; Behrmann et al., 1990). Some authors generally recommend primary intramedullary femoral nailing in multiple trauma patients (Bone, 1993).