Evaluation of Potential Fat Emboli During Placement of Intramedullary Nails After Orthopedic Fractures

Aoki, Noriaki; Soma, Kazui; Shindo, Mitsuko; Kurosawa, Toshiro; Ohwada, Takashi

doi:10.1378/chest.113.1.178

Cited by 50 publications

(26 citation statements)

References 12 publications

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“…When TEE was used to visualize the right portion of the heart, emboli of various sizes were seen in patients with long bone fractures, and the appearance of the emboli coincided with the manipulation and reaming of the fracture [38]. These emboli were apparently delivered to the pulmonary circulation because staining for lipoid material obtained from bronchoalveolar lavage of these patients showed that such material increased significantly in those with highly echogenic material by TEE [39]. However, because not all patients with large emboli in this study developed the clinical syndrome of fat embolism, a factor other than mechanical obstruction by fat globules may be necessary for the development of FES.…”

Section: Review Of Literaturementioning

confidence: 99%

Bone marrow embolism in sickle cell disease: A review

et al. 2005

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The fat embolism syndrome is an important complication of patients with sickle cell hemoglobinopathies because of severe morbidity and mortality. Our recent experience with three cases that survived with intensive supportive care and prompt use of transfusion stimulates this review. A high index of suspicion, prompt use of diagnostic tools, and aggressive clinical management are the keys to a successful outcome. Am.

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Section: Review Of Literaturementioning

confidence: 99%

Bone marrow embolism in sickle cell disease: A review

et al. 2005

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“…Direct observation of fat droplets in the blood, urine, or sputum samples has been sought as well as visualization of lipid-laden macrophages from bronchoalveolar lavage specimens. 11 Transesophageal echocardiography can document circulating embolic particles; however, the clinical significance of these emboli is circumspect. Christie et al used this modality to show that embolic events through a patent foramen ovale were associated with a much greater mortality.…”

Section: Discussionmentioning

confidence: 99%

Posttraumatic Paradoxical Fat Embolism to the Brain: A Case Report

Nastanski

Gordon

Lekawa

2005

The Journal of Trauma: Injury, Infection, and Critical Care

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“…This finding is supported by other studies which suggest that embolic material in itself is insufficient to generate a significant adverse clinical response and requires other 'triggering' factors. 51,52 Coagulopathy has been implicated for a long time in the pathogenesis of post-traumatic lung insufficiency states, including the fat embolus syndrome. 8,[14][15][16][17][18] A common pathway for these more severe responses may be that preactivation of the coagulative pathways, platelets and inflammatory mediators is present, producing an enhanced activation of these pathways after nailing.…”

Section: Discussionmentioning

confidence: 99%

The coagulative and cardiorespiratory responses to reamed intramedullary nailing of isolated fractures

Robinson

Ludlam

Ray

et al. 2001

The Journal of Bone and Joint Surgery. British volume

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We measured the changes during operation in seven markers of coagulation in a prospective series of 84 patients with fractures of the tibia or femur who were undergoing reamed intramedullary nailing. All patients were also continually monitored using transoesophageal echocardiography to assess marrow embolism. In a subset of 40 patients, intraoperative cardiopulmonary function was monitored, using pulmonary and systemic arterial catheterisation.The procedure produced a significant increase in prothrombin time, activated partial thromboplastin time, the level of prothrombin fragments F 1+2 and D-dimers, and a decrease in the fibrinogen level, suggesting activation of both the coagulation and fibrinolytic pathways. There was evidence of both platelet hyper-reactivity and depletion, as estimated by an increase in ␤-thromboglobulin levels and a decrease in the platelet count. In the patients who had invasive monitoring there was an incremental increase in mean pulmonary arterial pressure, with the changes being greatest during insertion of the guide-wire and reaming.The change in markers of coagulation, pulmonary artery pressure and arterial oxygen partial pressures correlated with the intraoperative embolic response. Greater changes in these parameters were observed during stabilisation of pathological fractures and in those patients in whom surgery had been delayed for more than 48 hours.Seven patients with pathological fractures developed more severe hypoxic episodes during reaming, which were associated with significantly greater arterial hypoxaemia, a fall in the right ventricular ejection fraction and an increase in the mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure and the pulmonary vascular resistance index. These changes suggested that the patients had transient intraoperative right heart strain.Eight patients developed significant postoperative respiratory compromise. They all had severe intraoperative embolic responses and, in the three who had invasive monitoring, there was a significantly greater increase in pulmonary artery pressure and alveolar-arterial oxygen gradient, and a fall in the ratio of arterial partial pressure of oxygen to the inspired oxygen concentration. Operative delay, intraoperative paradoxical embolisation and the scores for the severity of the coagulative and embolic responses were predictive of the development of postoperative respiratory complications on univariate logistic regression analysis. On multivariate analysis, however, only the embolic and coagulative scores were significant independent predictors of respiratory complications.

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Evaluation of Potential Fat Emboli During Placement of Intramedullary Nails After Orthopedic Fractures

Cited by 50 publications

References 12 publications

Bone marrow embolism in sickle cell disease: A review

Bone marrow embolism in sickle cell disease: A review

Posttraumatic Paradoxical Fat Embolism to the Brain: A Case Report

The coagulative and cardiorespiratory responses to reamed intramedullary nailing of isolated fractures

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