title: Fat embolism and death during prophylactic osteosynthesis of a metastatic femur using an unreamed femoral nail.
abstract: We report a case of cardiovascular collapse and death occurring intraoperatively during the prophylactic nailing of a metastatic femur using an unreamed femoral nail. The cause of death, as documented by the autopsy, was a massive fat embolism. The risk of fat embolism while performing intramedullary nailing is well known and has been linked to the process of medullary reaming. Unreamed femoral interlocking nails recently have become available. Although recent reports in the literature have concluded that the risk of fat embolism appears less likely while using unreamed implants, the surgeon should carefully consider the indications for any type of intramedullary fixation, particularly when dealing with unbroken femurs exhibiting impending pathologic fracture, or when preexisting pulmonary disease such as metastasis is present.
authors.affiliation: Clinique d'Orthopédie et de Traumatologie de l'Appareil Moteur, Hôpital Cantonal, Universitaire de Genève, Switzerland.
authors.forename: R E
authors.initials: RE
authors.lastname: Peter
authors.forename: A
authors.initials: A
authors.lastname: Schopfer
authors.forename: B
authors.initials: B
authors.lastname: Le Coultre
authors.forename: P
authors.initials: P
authors.lastname: Hoffmeyer
mesh_terms: D000368:Aged; D001858:Bone Nails; D004620:Embolism, Fat / Q000209:etiology*; D017809:Fatal Outcome; D005264:Femoral Fractures / Q000209:etiology / Q000517:prevention & control; D005266:Femoral Neoplasms / Q000150:complications / Q000556:secondary; D005269:Femur / Q000601:surgery*; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D019736:Prostheses and Implants