Pulmonary fat embolism after reamed and unreamed nailing of femoral fractures |
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| Authors: | F Högel UV Gerlach NP Südkamp CA Müller |
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| Institution: | aBerufsgenossenschaftliche Unfallklinik Murnau e.V., Murnau, Germany;bAlbert-Ludwig-University of Freiburg, Department of Pathology, Institute of Pathology, Breisacher Strasse 115 a, D-79106 Freiburg, Germany;cAO/ASIF-Research Institute Davos, Clavadeler Strasse, CH-7270 Davos, Switzerland;dAlbert-Ludwig-University of Freiburg, Orthopaedic and Trauma Department, Hugstetter Strasse 55, D-79106 Freiburg, Germany;eStädtisches Klinikum Karlsruhe, Dep. of Trauma and Reconstruction Surgery, Moltke Str. 90, 76133 Karlsruhe, Germany |
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| Abstract: | BackgroundTo determine whether reamed or unreamed intramedullary nailing of femoral fractures results in higher incidence of pulmonary fat embolism, three different methods of intramedullary nailing were compared in sheep. To analyze the presence of bone marrow fat embolism in pulmonary arteries, histological evaluation was undertaken using a quantitative computer-assisted measurement system.MethodsIn this experimental model of 27 female Swiss alpine sheep, an osteotomy of the proximal femur was conducted in each animal. Then, the animals were divided into three groups according to the method of treatment: two different reamed intramedullary nailing techniques and an unreamed nailing technique were used.In the first group “ER” (experimental reamer; n = 9), the nail was inserted after reaming with an experimental reamer; in the second group “CR” (conventional reamer; n = 7), the intramedullary nail was inserted after reaming with the conventional AO-reamer. In the third group “UN” (unreamed; n = 8) unreamed nailing was performed. During the operation procedure intramedullary pressure was measured in the distal fragment.After sacrificing the animals, quantitative histological analyses of bone marrow fat embolism in pulmonary arteries were done using osmium tetroxide fixation and staining of the fat.ResultsThe measurement of intramedullary pressure showed significantly lower values for reamed nailing than for the unreamed technique. The quantitative histological evaluation of lung vessels concerning bone marrow fat embolism revealed a statistically significant difference between reamed and unreamed insertion of the nail: 7.77% ± 6.93 (ER) and 6.66% ± 5.61 (CR) vs. 16.25% ± 10.05 (UN) (p < 0.05) of the assessed lung vessels were filled with fat emboli. However, no difference was found between the traditional and experimental reamer.ConclusionsIntramedullary nailing after reaming is a safe procedure with low systemic embolisation when compared to the unreamed insertion of the nail. |
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| Keywords: | Fat embolism Intramedullary nailing Femur fractures |
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