title: Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing.
abstract: This study was designed to investigate whether intramedullary pressure and embolization of bone marrow fat are different in unreamed compared with conventional reamed femoral nailing in vivo. In a baboon model, the femoral shaft was stabilized with interlocking nailing after a midshaft osteotomy. Intramedullary pressure was measured in the distal femoral shaft fragment at the supracondylar region. Extravasation of bone marrow fat was determined by the modified Gurd test (range: 0-5) with blood samples from the vena cava inferior. Data were monitored in eight unreamed and eight reamed intramedullary femoral nailing procedures. Intramedullary pressure increased in the unreamed group to 76 +/- 25 mm Hg (10.1 +/- 3.3 kPa) during insertion of 7-mm nails and in the reamed group to 879 +/- 44 mm Hg (117.2 +/- 5.9 kPa) during reaming of the medullary cavity. Insertion of 9-mm nails after the medullary cavity had been reamed to 10 mm produced an intramedullary pressure of 254 +/- 94 mm Hg (33.9 +/- 12.5 kPa) (p < 0.05). Fat extravasation in the unreamed group was recorded with a score of 2.9 +/- 0.4 for the Gurd test during nailing with 7-mm nails, whereas in the reamed group significantly more fat extravasation was noticed during the reaming procedures, with a score of 4.6 +/- 0.1. Liberation of fat during insertion of 9-mm nails after reaming was recorded with a score of 3.5 +/- 0.4. In both groups, a positive correlation of fat extravasation with the rise in intramedullary pressure was found (reamed group: r(s) = 0.868; unreamed group: r(s) = 0.698), resulting in significantly less liberation of bone marrow fat in the unreamed stabilized group than in the reamed control group (p < 0.05). The data indicate that fat embolization during nailing procedures after femoral osteotomy increases with increasing intramedullary pressure and occurs in a lesser degree in unreamed than in reamed intramedullary femoral shaft stabilization.
authors.affiliation: Trauma Centre Unfallkrankenhaus, Salzburg, Austria. akroepfl@netway.at
authors.forename: A
authors.initials: A
authors.lastname: Kröpfl
authors.forename: J
authors.initials: J
authors.lastname: Davies
authors.forename: U
authors.initials: U
authors.lastname: Berger
authors.forename: H
authors.initials: H
authors.lastname: Hertz
authors.forename: G
authors.initials: G
authors.lastname: Schlag
mesh_terms: D000818:Animals; D001853:Bone Marrow; D001858:Bone Nails / Q000009:adverse effects*; D004195:Disease Models, Animal; D004620:Embolism, Fat / Q000097:blood / Q000209:etiology* / Q000473:pathology; D005264:Femoral Fractures / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005269:Femur / Q000293:injuries / Q000503:physiopathology* / Q000601:surgery*; D005272:Femur Neck; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D008297:Male; D010027:Osteotomy; D010215:Papio; D011312:Pressure