Pathophysiological aspects of lower limb oedema in patients with proximal femoral fractures

Abstract

Objectives: To examine the changes in Starling components, regulating the transcapillary fluid transport, in patients with proximal femoral fractures (PFF).

Material and methods: Twenty-eight patients with proximal femoral fracture were classified into femoral column fracture (FCF) and pertrochanteric fracture (PTF) groups. The following measurements were made in both groups of patients on the 7th post-operative day: colloid osmotic pressure of plasma and subcutaneous interstitial fluid (COP(pl) and COP(if)), capillary filtration coefficient (CFC) and interstitial fluid pressure (P(if)) in the anterior muscle compartment of the leg and calf muscle blood flow, in both lower extremities.

Results: The transcapillary colloid osmotic gradient was significantly reduced (p<0.02) in patients with PTF, and they also showed a significant increase in CFC values (p=0.038). Moreover, P(if) was elevated (1.9 mmHg, SD 2.1, p=0.01) and calf muscle blood flow was significantly higher (p=0.02), than in the contralateral limb in patients with PTF.

Conclusion: The transcapillary colloid osmotic gradient is significantly reduced in patients with PTF. This may partly explain why patients with PTF develop more oedema in the lower limb than those with FCF. CFC and calf blood flow are also significantly increased in the fractured limb, which allows increased transcapillary filtration.