Pulmonary and Systemic Fat Embolization after Medullary Canal Pressurization

Schemitsch, Emil H.; Turchin, DC; Anderson, Gail I.; Byrick, Robert J.; Mullen, J. B. M.; Richards, Robin R.

doi:10.1097/00005373-199810000-00019

Cited by 61 publications

(31 citation statements)

References 12 publications

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“…It has been suggested that the monomer causes systemic vasodilatation (Peebles et al 1972, Berman et al 1974, Samii et al 1980. However, the currently accepted mechanism is the microembolisation of the arterioles and capillaries in the lungs due to the extravasation of bone marrow particles, leading to cardiovascular deterioration (Breed 1974, Orsini et al 1987, Wheelwright et al 1993, Schemitsch et al 1998, Aebli et al 2002. Other explanations have included a nerve reflex triggered by the increase in pressure within the bone marrow cavity during manipulations (i.e.…”

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confidence: 99%

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Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

et al. 2005

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Background Fat embolism (FE), the release of bone marrow contents into the circulation and the subsequent cardiovascular changes, is still a potentially fatal complication during orthopedic surgery. Different causative factors have been suggested, but the exact pathomechanism of FE still remains unclear. We investigated the role of polymethylmethacrylate (PMMA) in FE during vertebroplasty in sheep.Methods In 8 sheep, two vertebral bodies were augmented alternatively with PMMA or bone wax. Pulmonary and cardiovascular parameters were monitored during the procedure.Results The peak response was similar for both groups and characterized by hypotension, a drop in cardiac output and pulmonary hypertension. However, the recovery in pulmonary arterial pressure and pulmonary vascular resistance was quicker in the wax group.Interpretation The injection of PMMA may cause prolonged pulmonary hypertension during vertebroplasty and also arthroplasty. Surgeons should be aware of this potential cardiovascular complication, especially in patients with impaired pulmonary and cardiovascular function.

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confidence: 99%

“…In the past, different animal models have been used to investigate FE (Breed 1974, Rudigier and Ritter 1983, Orsini et al 1987, Wheelwright et al 1993, Schemitsch et al 1998. Recently, an animal model of vertebroplasty has been developed to investigate FE (Aebli et al 2002).…”

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Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

et al. 2005

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“…This may be a result of the vulnerability of the lung tissue due to high blood circulation and accumulation of systemically released inflammatory mediators and immune cells. Furthermore, Schemitsch et al [31] reported lung injury without associated systemic inflammation might be related to the liberation of fat content after long-bone fractures. OPN, a component of extracellular bone matrix, is a protein with diverse functions in the immune system.…”

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confidence: 99%

Cumulative Effects of Bone and Soft Tissue Injury on Systemic Inflammation: A Pilot Study

Pfeifer

Darwiche

Kohut

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background In multiply injured patients, bilateral femur fractures invoke a substantial systemic inflammatory impact and remote organ dysfunction. However, it is unclear whether isolated bone or soft tissue injury contributes to the systemic inflammatory response and organ injury after fracture. Questions/purposes We therefore asked whether the systemic inflammatory response and remote organ dysfunction are attributable to the bone fragment injection, adjacent soft tissue injury, or both. Methods Male C57/BL6 mice (8-10 weeks old, 20-30 g) were assigned to four groups: bone fragment injection (BF, n = 9) group; soft tissue injury (STI, n = 9) group; BF + STI (n = 9) group, in which both insults were applied; and control group, in which neither insult was applied. Animals were sacrificed at 6 hours. As surrogates for systemic inflammation, we measured serum IL-6, IL-10, osteopontin, and alanine aminotransferase (ALT) and nuclear factor (NF)-jB and myeloperoxidase (MPO) in the lung. Results The systemic inflammatory response (mean IL-6 level) was similar in the BF (61.8 pg/mL) and STI (67.9 pg/mL) groups. The combination (BF + STI) of both traumatic insults induced an increase in mean levels of inflammatory parameters

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“…21 Further studies in animal models have shown that intravascular fat appears to produce a negligible inflammatory response. 27,31,32 The importance of fat as a cause of ARDS in the multiply-injured patient therefore remains in doubt. 33 There is often ample evidence of other secondary triggers for ARDS after injury, 34,35 and the role of FE is difficult to define.…”

Section: Fat Embolisation After Fracture: Is It Important?mentioning

confidence: 99%

Current Concepts of Respiratory Insufficiency Syndromes After Fracture

Robinson

2001

The Journal of Bone and Joint Surgery. British volume

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Pulmonary and Systemic Fat Embolization after Medullary Canal Pressurization

Abstract: This study is the first to show that intravascular fat persists in the lungs, kidneys, and brain for 72 hours after canal pressurization and, by itself, does not cause pathologic evidence of acute inflammation.

Cited by 61 publications

References 12 publications

Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

Cumulative Effects of Bone and Soft Tissue Injury on Systemic Inflammation: A Pilot Study

Current Concepts of Respiratory Insufficiency Syndromes After Fracture

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