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Monitoring and controlling intramedullary pressure increase in long bone instrumentation: A study on sheep
Author(s) -
Smith Paul N.,
Leditschke Anne,
McMahon Damian,
Sample Roxanne R.,
Perriman Diana,
Prins Anne,
Brüssel Thomas,
Li Rachel W.
Publication year - 2008
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.20564
Subject(s) - intramedullary rod , fat embolism , medullary cavity , suction , medicine , hemodynamics , blood pressure , anesthesia , oxygen saturation , anatomy , surgery , chemistry , oxygen , mechanical engineering , organic chemistry , engineering
Intramedullary reamed nailing causes elevation in intramedullary pressure and extravazation of intramedullary contents into the venous blood system. This study investigated the effect of an intramedullary suction system, recently developed in our laboratory, on the pressure and fat extravazation in isolated bovine bone and a sheep model. During reaming, the pressure with and without suction was recorded at each step of the procedure. Hemodynamic parameters of mean arterial blood pressure, pulmonary artery pressure, pulmonary arterial CO 2 (PaCO 2 ), heart rate, and oxygen saturation were monitored. Blood and lung tissue samples were collected for the examination of medullary fat intravazation. The increases of intramedullary pressure were dramatically reduced in the suction group ( p < 0.05) in both in vitro and in vivo experiments. PaCO 2 was significantly lower in the suction group than nonsuction group (32 vs. 40 mmHg, respectively, p = 0.02), while oxygen saturation was higher in the suction group (99 vs. 91 mmHg, respectively, p = 0.009). Histological data revealed a significant higher count of fat emboli in sheep lung tissue in the nonsuction group. Total lipids in lung specimens was lower in the suction group (7.6 mg/g tissue) than in the nonsuction group (13.6 mg/g, p = 0.04). The suction system appears to control the surge in intramedullary pressure and therefore prevent fat embolism. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1327–1333, 2008