Intramedullary Pressure and Bone Marrow Fat Intravasation in Unreamed Femoral Nailing

Kröpfl, A.; Berger, U.; Neureiter, H.; Hertz, H.; Schlag, G.

doi:10.1097/00005373-199705000-00028

Cited by 85 publications

(37 citation statements)

References 31 publications

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“…Although the employment of unreamed medullary nailing reduced the increase in intramedullary pressure and the intravazation of bone marrow components, 12 experiments showed an increase in pressure above the physiological level accompanied by a clinical relevant intravasation of bone marrow components. 13 The reason for this is the stamp effect that leads to an increase in pressure when the nail is inserted.…”

Section: Discussionmentioning

confidence: 94%

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Schult

Küchle²,

Hofmann³

et al. 2006

Journal Orthopaedic Research

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Although reamed intramedullary nailing has been one of the greatest advances in modern fracture care, the concomitant increase in medullary cavity pressure leads to intravasation of bone marrow content into the blood stream, an effect that can evoke serious systemic reactions. A newly developed rinsing-suction-reamer (RSR) was able to substantially reduce the pressure and bone marrow intravasation content during experimental femoral nailing. We investigated the pathophysiological effects using the RSR, testing the hypothesis that by reducing marrow fat embolization, RSR would also reduce the activation of coagulation compared with the universial AOReamer (AOR) and comparable to external fixation. Twenty-two pigs were treated with either simulated external fixation or reamed femoral nailing using AOR or RSR. During surgery, the intramedullary pressure was measured and intravasation of medullary material was quantified. After surgery, the pigs were kept anaesthetised and monitored for 6 h. At defined intervals, serological, hematological, and hemodynamic parameters were evaluated. The RSR was significantly superior when compared to AOR with regard to the generation of intramedullary pressure and fat embolization; however, with external fixation the values were even lower. The evaluation of other parameters revealed no clear differences between the two reamers and the external fixator. The pig model showed that RSR led to a significant reduction of the intramedullary increase in pressure and fat intravasation compared to AOR. Although the reduction of fat embolism by RSR is not associated with pathophysiological changes, RSR can have advantages for the treatment of femoral fractures.

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Section: Discussionmentioning

confidence: 94%

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Schult

Küchle²,

Hofmann³

et al. 2006

Journal Orthopaedic Research

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“…The unreamed technique uses a smaller device with theoretical advantages re- garding all these risks. Kropfl et al (1997) reported that bone marrow intravasation occurred less frequently in unreamed than in reamed intramedullary femoral fracture stabilization.…”

Section: Discussionmentioning

confidence: 99%

Unreamed intramedullary nailing for pathological femoral fractures : Good results in 30 cases

et al. 1999

Acta Orthopaedica Scandinavica

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“…The relationship between intramedullary pressure and FE has led to the development of specific strategies in trauma surgery [90]. External fixation or fixation with a plate produces less lung injury than intramedullary fixation [66].…”

Section: Surgical Strategies For Preventing Fesmentioning

confidence: 99%

Fat embolism

2001

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SummaryFat embolism syndrome is a collection of respiratory, haematological, neurological and cutaneous symptoms and signs associated with trauma and other disparate surgical and medical conditions. The incidence of the clinical syndrome is low (, 1% in retrospective reviews) whilst the embolisation of marrow fat appears to be an almost inevitable consequence of long bone fractures. There is debate over the pathogenesis of fat embolism syndrome and it seems a variety of factors interact to produce a spectrum of end organ damage. Many therapeutic interventions and prophylactic strategies have been tried with varying success. Current treatments are supportive and the condition is usually associated with a good outcome. The literature on fat embolism syndrome is extensive and this review aims to discuss the incidence, aetiology, pathophysiology, diagnosis and treatment of fat embolism.

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Intramedullary Pressure and Bone Marrow Fat Intravasation in Unreamed Femoral Nailing

Abstract: Intramedullary pressure increased significantly in the reamed more than in the unreamed group. Bone marrow fat intravasation depended on the rise in intramedullary pressure, and occurred less frequently in unreamed than in reamed intramedullary femoral fracture stabilization.

Cited by 85 publications

References 31 publications

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Pathophysiological advantages of rinsing‐suction‐reaming (RSR) in a pig model for intramedullary nailing

Unreamed intramedullary nailing for pathological femoral fractures : Good results in 30 cases

Fat embolism

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