Additional inflammation caused by surgery is seen as additional trauma and has been considered as a possible risk factor for organ failure such as ARDS [18]. Much to our surprise the increased damage caused by IMN only partly induced changes in the systemic inflammatory response (only monocyte

HLA-DR expression in patients with isolated femur Vistusertib supplier fractures). Most striking was the absence of additional PMN activation after intramedullary nailing. This lack of change in PMN phenotype during IMN is in line with suggestions from a previously published report [19]. In that cohort, no increase was seen in MAC-1 expression on PMNs after bilateral femur fracture fixation. Thus, the extend of PMN activation appears mainly determined by the severity of initial trauma and is apparently not altered by intramedullary nailing. In contrast, plasma IL-6 levels and monocyte HLA-DR were significantly altered by intramedullary nailing. Thus, an impact of the surgical procedure can be measured by cytokines and the monocyte compartment. The blood samples were taken 1 hour prior to IMN and 18 hours after IMN, regardless of the interval between trauma and surgery. Although this affects the reproducibility of the results, it reflects daily care practice. 18 hours after IMN the peak of plasma IL-6 levels will be passed (max

at 6 hours post-operatively), but the changes in PMN phenotype will be NVP-BSK805 most defined. PMN phenotype behaved similarly in all patients, therefore, 38 patients were sufficient to state the conclusion. Because we analyzed the functional phenotype of PMNs and monocytes, more information was obtained than merely static phenotypes. The inflammatory cellular response deficit to the development of ARDS appears to be mainly determined by the initial injuries

and not the additional insult by IMN. Acknowledgements This project was funded by the AO Foundation, grant S-06-14H. References 1. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al.: Incidence and outcomes of acute lung injury. N engl j med 2005, 20;353:1685–1693.CrossRef 2. Pape HC, Auf’m'kolk M, Paffrath T, Regel G, Sturm JA, Tscherne H: Primary intramedullary femur fixation Isoconazole in multiple trauma patients with associated lung contusion–a cause of posttraumatic ards? J trauma 1993, 34:540–547.PubMedCrossRef 3. Bosse MJ, Mackenzie EJ, Riemer BL, Brumback RJ, Mccarthy ML, Burgess AR, et al.: Adult respiratory distress syndrome, pneumonia, and mortality following thoracic injury and a femoral fracture treated either with intramedullary nailing with reaming or with a plate. A comparative study. J bone joint surg am 1997, 79:799–809.PubMed 4. Dunham CM, Bosse MJ, Clancy TV, Cole FJ, Coles MJ, Knuth T, et al.: Practice management guidelines for the optimal timing of CP-690550 concentration long-bone fracture stabilization in polytrauma patients: the east practice management guidelines work group. J trauma 2001, 50:958–967.PubMedCrossRef 5.