The Effects of Femoral Intramedullary Reaming on Pulmonary Function in a Sheep Lung Model*

Duwelius, Paul J.; Huckfeldt, Roger; Mullins, Richard J.; Shiota, Tetsuhiro; Woll, T S; Lindsey, K H; Wheeler, Donna L.

doi:10.2106/00004623-199702000-00005

Cited by 95 publications

(42 citation statements)

References 20 publications

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“…Intramedullary devices are associated with higher pressures within the marrow cavity and more FE than extramedullary fixation [59,60]. Ultrasonographically, most emboli occur during opening and manipulation of the intramedullary cavity [61]. Intramedullary fat content is important and previously reamed femurs are associated with extremely low incidence of FES-type problems because of reduced intramedullary fat [62].…”

Section: Infloating Theorymentioning

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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Section: Infloating Theorymentioning

confidence: 99%

Fat embolism

2001

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“…Complications related to reaming include, higher levels of intramedullary pressure, pulmonary artery pressures, increased fat embolism and pulmonary dysfunction 20,7 . Furthermore, reaming is not recommended for open fractures, as it can cause problems, such as temporary damage to the internal cortical blood supply, which is associated with increased rates of infection 25 .…”

Section: Complications Associated With Reamingmentioning

confidence: 99%

A paradigm shift of the conventional intramedullary devices to new biological osteosynthetic devices: Bone stents

Munib¹,

Ansari²,

Ali³

et al. 2014

Int J of Biomed & Adv Res

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“…The resulting effects on cardiopulmonary function and gaseous exchange have been studied in animal models, but are not well documented in man. [8][9][10][11][12] The embolic load produced during most nailing procedures is mild and it is assumed that these responses are normally self-limiting and homeostatically controlled, so that most pass unnoticed when measured by standard clinical markers. A few patients with a fracture of a long bone, including those with pathological fractures or with a concomitant chest injury, are at increased risk of developing adult respiratory distress syndrome.…”

mentioning

confidence: 99%

“…[21][22][23] It is a matter of debate as to whether or not the use of reamed intramedullary nailing in these situations increases the risk of the development of this complication and this has recently been the focus of clinical and laboratory-based research. [8][9][10][11][12][24][25][26][27][28] Quantification of the normal responses to nailing in patients with isolated fractures, may enable us to understand the processes by which they become deranged in the multiply-injured patient who develops a post-traumatic lung syndrome. Our study aimed to quantify the coagulative and cardiorespiratory response to nailing of isolated fractures, using sensitive, invasive monitoring.…”

mentioning

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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The Effects of Femoral Intramedullary Reaming on Pulmonary Function in a Sheep Lung Model*

Cited by 95 publications

References 20 publications

Fat embolism

Fat embolism

A paradigm shift of the conventional intramedullary devices to new biological osteosynthetic devices: Bone stents

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

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