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Title: Damage control orthopaedics and the cognitive effects of cerebral fat embolus
Author: Gray, Andrew Colin
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2007
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This thesis consists of two clinical projects and a large animal (ovine) model of severe musculoskeletal trauma under terminal anaesthesia. It involved the analysis of haemodynamic, pulmonary embolic, coagulative and inflammatory response to bilateral femoral fractures and hypovolaemic shock comparing two different surgical strategies of fracture fixation (damage control versus early total care). This study aimed to better quantify the relative consequences of initial surgical management (external fixation versus intramedullary stabilisation) against a background of relative severe injury. Both clinical projects involved the use of Transcranial Doppler ultrasound monitoring of the cerebral circulation to quantify the cerebral embolic load, with detailed clinical cognitive testing and the measurement of a serum marker (S100B protein) of neuronal injury. One study involved trauma patients requiring intramedullary stabilisation of femoral and tibial diaphyseal fractures and the other examined patients undergoing primary lower limb arthroplasty. The primary aim of both studies was to accurately quantify cognitive change following surgery and to assess whether these measurements correlated with intraoperative cerebral embolic load and serum S100B protein concentrations following surgery. The animal study demonstrated a higher pulmonary embolic load with early intramedullary femoral fracture fixation compared to external fixation. However the initial fracture fixation method did not affect animal mortality or changes seen in the measured coagulation and inflammatory markers. Specific and quantifiable defects in cognitive function occurred following surgery in both clinical studies. However, no direct correlation was found between cognitive change and cerebral emboli detection. Altering surgical technique can reduce the embolic load. However a linear correlation between embolic load and clinical outcome was not established.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available