J Korean Orthop Assoc.  1999 Apr;34(2):357-363.

The Relationship between Fat Embolism and Intramedullary Reaming

• Kim JJ
• Jung CY
• Chang JS
• Lee SH
• Park CJ

Abstract

To evaluate leading mechanisms of fat embolism, we investigated patients who received femoral procedures prospectively. Forty patients were classified into three groups according to reaming procedures. Group A (10 cases) was the control group who operated with open reduction and internal fixation for peritrochanteric fractures. Group B (18 cases) was composed of hip arthroplasty patients and group C (12 cases) patients received intramedullary nailing procedures due to femoral shaft fracture. Pulmonary function test and chest X-ray were taken to evaluate pulmonary condition. Perfusion and inhalation radionuclide scan proved pulmonary embolism and fat embolism. Arterial blood gas analysis, lipid metabolites (cholesterol, triglyceride and NEFA (Non-esterified Fatty Acid)) and coagulation battery (PT, aPTT, TAT-III (Thrombin anti-thrombin III complex) and D-dimer) were measured in preoperative, intraoperative (reaming and post-reaming) and postoperative period, individually. Although two cases of fat embolism were verified only in group C preoperatively, there was no difference with the incidence of pulmonary embolism between reaming and non-reaming group (P<0.05). Blood gas analysis revealed no difference between control group and reaming one in each stage. NEFA in lipid metabolism was abruptly increased in group C only during reaming procedure. The titer of D-dimer and TAT-III were elevated specifically in fat embolism patients by reaming procedure. We suggest that D-dimer and TAT-III may be preliminary screening tools for the early diagnosis of fat embolism. And the coagulation system seems to be more related to fat embolism rather than lipid metabolism.

Keyword

Fat embolism; Femur; Intramedullary reaming; D-dimer; TAT-III

MeSH Terms

Arthroplasty
Blood Gas Analysis
Early Diagnosis
Embolism, Fat*
Fatty Acids, Nonesterified
Femur
Fracture Fixation, Intramedullary
Hip
Humans
Incidence
Inhalation
Lipid Metabolism
Mass Screening
Perfusion
Postoperative Period
Prospective Studies
Pulmonary Embolism
Respiratory Function Tests
Thorax
Triglycerides
Fatty Acids, Nonesterified