Intramedullary Pressure Changes and Fat Intravasation During Intramedullary Nailing

Wozasek, Gerald E.; Simon, Paul; Redl, Heinz; Schlag, G.

doi:10.1097/00005373-199402000-00010

Cited by 142 publications

(56 citation statements)

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“…It is noted that Pape et al attempted to validate the sheep model and concluded that 'the effect of IM instrumentation in sheep is less pronounced than in humans' [29]. Several of the studies [12][13][14][15][16] measured IM pressures as a measure of FE, and whilst elevated IM pressures have been shown to be associated with FE [30], this is an indirect measurement and some studies have suggested this per se may not be directly related [31]. In addition, the threshold at which FE in humans occurs is unknown, although we note the work from Wenda et al suggesting a 200-mmHg threshold in the sheep model [32].…”

Section: Prevention Of Fat Embolism and Thermal Necrosismentioning

confidence: 99%

Reamer-irrigator-aspirator indications and clinical results: a systematic review

Cox

Jones

McGonagle

et al. 2011

International Orthopaedics (SICOT)

124

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Background The 'reamer-irrigator-aspirator' (RIA) is an innovation developed to reduce fat embolism (FE) and thermal necrosis (TN) that can occur during reaming/ nailing of long-bone fractures. Since its inception its indications have expanded to include the treatment of long-bone osteomyelitis and as a harvester of bone graft/ mesenchymal stem cells (MSCs). Methods This study involved a systematic review, via Pubmed® and Google Scholar®, of English language sources (nine non-clinical studies, seven clinical studies and seven case reports) using the keywords: 'reamer', 'irrigator', 'aspirator' (1st May 2010). Sources were reviewed with reference to the RIAs efficacy in (1) preventing FE/TN, (2) treating long-bone osteomyelitis, (3) harvesting bone graft/MSCs, and (4) operating safely. Experimental data supports the use of the RIA in preventing FE and TN, however, there is a paucity of clinical data. Conclusions The RIA is a reliable method in achieving high volumes of bone graft/MSCs, and high union rates are reported when using RIA bone-fragments to treat nonunions. Evidence suggests possible effectiveness in treating long-bone osteomyelitis. The RIA appears relatively safe, with a low rate of morbidity provided a meticulous technique is used. When complications occur they respond well to conventional techniques. The RIA demands further investigation especially with respect to the optimal application of MSCs for bone repair strategies.

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Section: Prevention Of Fat Embolism and Thermal Necrosismentioning

confidence: 99%

Reamer-irrigator-aspirator indications and clinical results: a systematic review

Cox

Jones

McGonagle

et al. 2011

International Orthopaedics (SICOT)

124

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“…In certain circumstances, with the collaborative effort of a skilled musculoskeletal pathologist and an orthopaedic oncologist, a definitive diagnosis can be rendered through frozen-section analysis, allowing for definitive treatment at the time of biopsy. Finally, canal reamings are not appropriate biopsy material because the act of reaming may damage the cellular elements, complicating pathologic diagnosis, and may result in intramedullary and systemic tumor dissemination, particularly to the lungs through embolic phenomena [7,15,25,27]. Therefore, six patients in our series (four of whom did not have metastasis at referral) potentially were exposed to malignant emboli through intramedullary reaming at the index procedure.…”

Section: Discussionmentioning

confidence: 99%

Consequences and Prevention of Inadvertent Internal Fixation of Primary Osseous Sarcomas

Adams¹,

Potter²,

Mahmood³

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…2,36 In addition, marrow contents are known to be thrombogenic causing activation of the coagulation and fibrinolytic pathways, as well as that which would be expected from the surgical stimulus alone. 2,3,37 Although the coagulative and cardiopulmonary effects of replacement arthroplasty of the hip and knee have previously been examined, 38,39 this is the first clinical study to attempt specifically to quantify these effects in patients undergoing reamed nailing. We have shown that reamed nailing is associated with the activation of coagulation pathways.…”

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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Intramedullary Pressure Changes and Fat Intravasation During Intramedullary Nailing

Cited by 142 publications

References 0 publications

Reamer-irrigator-aspirator indications and clinical results: a systematic review

Reamer-irrigator-aspirator indications and clinical results: a systematic review

Consequences and Prevention of Inadvertent Internal Fixation of Primary Osseous Sarcomas

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

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