title: Cerebral microemboli during hip fracture fixation: a prospective study.
abstract: BACKGROUND
  Recent studies have shown that cerebral fat microembolism takes place during surgery for hip or knee replacement. In this study, we examined the occurrence of cerebral microembolism, solid or gas, during a standard procedure of hip fracture fixation.
  
  
  METHODS
  This was a prospective study of patients who underwent urgent surgery with a dynamic hip screw for hip fracture fixation. During surgery, patients were monitored with transcranial Doppler for detection of microemboli from right and left middle cerebral arteries.
  
  
  RESULTS
  Twenty-two patients were included in the study; their median age was 82 yr (range, 51-97 yr). In nine (41%) patients, high intensity transient signals were recorded, indicating microemboli passage in the middle cerebral arteries. All nine patients had signals of both solid and gas emboli. One of these nine patients had a postoperative cerebrovascular accident.
  
  
  CONCLUSIONS
  The incidence of cerebral microemboli during urgent surgery for hip fracture fixation is considerable. This phenomenon is not confined to hip or knee replacement surgery. The clinical implications of this finding require further investigation.
authors.affiliation: Department of Anesthesiology, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Barak
authors.forename: Majed
authors.initials: M
authors.lastname: Kabha
authors.forename: Doron
authors.initials: D
authors.lastname: Norman
authors.forename: Michael
authors.initials: M
authors.lastname: Soudry
authors.forename: Yeshayahu
authors.initials: Y
authors.lastname: Kats
authors.forename: Simcha
authors.initials: S
authors.lastname: Milo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology; D003693:Delirium / Q000209:etiology; D004618:Embolism, Air / Q000209:etiology; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial