Transesophageal Echocardiography in Quantification of Emboli During Femoral Nailing: Reamed Versus Unreamed Techniques


ABSTRACT: We quantified the embolic load to the lungs created with two different techniques  of femoral nailing. Eleven patients with 12 traumatic femur fractures were randomized to  reamed (7 fractures) and unreamed (5 fractures) groups. Intramedullary nailing was with the  AO/ASIF* universal reamed or unreamed nail. Transesophageal echocardiography (TEE) was  used to evaluate the quantity and quality of emboli generated by nailing. Data were analyzed  using software that digitized the TEE images and quantified the area of embolic particles in  each frame. The duration of each level of embolic phenomena (zero, moderate, severe) was  used to determine total embolic load with various steps (fracture manipulation, proximal portal opening, reaming, and nail passage). Manual grading of emboli correlated highly with software quantification. Our data confirm the presence and similarity of emboli generation  with both methods of intramedullary nailing. Unreamed nails do not protect the patient from  pulmonary embolization of marrow contents.

SKU: JSAO-2000-9-2-SP3 Categories: ,

Robert E. Coles, MD; Fiona M. Clements, MD; J. W. Lardenoye, MD; G. V. Wermeskerken, MD; Lloyd A. Hey, MPH, MD; James A. Nunley, MD; L. Scott Levin, MD; Albert W. Pearsall IV, MD