Cerebral microemboli during hip fracture fixation: a prospective study.
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.
Barak
Michal
M
Department of Anesthesiology, Rambam Health Care Campus and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Kabha
Majed
M
Norman
Doron
D
Soudry
Michael
M
Kats
Yeshayahu
Y
Milo
Simcha
S
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