The effect of unreamed and reamed intramedullary nailing on the urinary excretion of prostacyclin and thromboxane A2 metabolites in patients with tibial shaft fractures.

Abstract

To compare the effects of unreamed and reamed intramedullary nailing on the systemic production of prostacyclin and thromboxane A2 as assessed, respectively, by determinations of urinary 2,3-dinor-6-ketoprostaglandin F1alpha and 11-dehydrothromboxane B2 excretion. Ten otherwise healthy patients with closed and simple tibial shaft fractures were treated with unreamed intramedullary nailing, and 10 otherwise healthy patients with closed and simple tibial shaft fractures were treated with reamed intramedullary nailing. Urine was collected preoperatively and during the next 5 postoperative days. The samples were stored at -70 degrees C until assayed at the end of the study. In the unreamed group, urinary 2,3-dinor-6-ketoprostaglandin F1alpha and 11-dehydrothromboxane B2 excretion remained stable and at a significantly lower levels compared with the reamed group during the entire study period (p < 0.021). In the reamed group, the alteration in urinary 2,3-dinor-6-ketoprostaglandin F1alpha excretion preoperatively and on the first postoperative day was nearly significant (p=0.075), and the increase in urinary 11-dehydrothromboxane B2 excretion was significant (p=0.020). The proportional increase compared with baseline, however, was 1.6 times greater for 11-dehydrothromboxane B2 than for 2,3-dinor-6-ketoprostaglandin F1alpha. Only reamed intramedullary nailing elevates urinary 2,3-dinor-6-ketoprostaglandin F1alpha and 11-dehydrothromboxane B2 concentrations and their ratio (thromboxane A2/prostacyclin production) in patients with simple tibial shaft fractures.