title: Influence of controlled reaming on fat intravasation after femoral osteotomy in sheep.
abstract: This study assessed the influence of driving speed and revolution rate per minute of two reamers on femoral intramedullary pressure increases and fat intravasation. The AO and Howmedica reamers were tested in four groups with different combinations of driving speed and revolution rate per minute in both femurs in a sheep model. The 24 animals were exposed to hemorrhagic shock after midshaft osteotomy and were resuscitated before reaming of both femoral shafts. Controlled reaming was performed at 15 and 50 mm/second driving speed with 150 and 450 revolutions per minute. Fat intravasation and intramedullary pressure were measured by transesophageal echocardiography, Gurd test, and a piezoelectric gauge, respectively. Low driving speed and high revolutions per minute with the smaller cored reamer led to lower intramedullary pressure changes. The same reaming parameters led to greater pulmonary stress during surgery of the second side. Reaming with a smaller cored reamer and modified reaming parameters leads to a lower increase in intramedullary pressure and reduces the amount of fat intravasation. Primary reamed intramedullary nailing should be done after resuscitation at a low driving speed and high revolutions per minute with a smaller cored reamer to minimize the risk of pulmonary dysfunction.
authors.affiliation: University Clinic for Trauma Surgery, Vienna, Austria.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mousavi
authors.forename: Roland
authors.initials: R
authors.lastname: David
authors.forename: Ilse
authors.initials: I
authors.lastname: Schwendenwein
authors.forename: Eva
authors.initials: E
authors.lastname: Schaden
authors.forename: Stefan
authors.initials: S
authors.lastname: Marlovits
authors.forename: Alexander
authors.initials: A
authors.lastname: Kolonja
authors.forename: Erhard
authors.initials: E
authors.lastname: Schwanzer
authors.forename: Thomas
authors.initials: T
authors.lastname: Heinz
authors.forename: Vilmos
authors.initials: V
authors.lastname: Vécsei
mesh_terms: D000818:Animals; D001858:Bone Nails / Q000009:adverse effects; D004195:Disease Models, Animal; D017548:Echocardiography, Transesophageal; D004620:Embolism, Fat / Q000000981:diagnostic imaging* / Q000209:etiology*; D004867:Equipment Design; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D006439:Hemodynamics; D010027:Osteotomy / Q000009:adverse effects* / Q000379:methods; D011336:Probability; D018570:Risk Assessment; D012307:Risk Factors; D012756:Sheep