Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain
Background:. Shaft fractures of the femur are commonly treated with intramedullary nailing, which can release bone marrow emboli into the bloodstream. Emboli can travel to the lungs, impairing gas exchange and causing inflammation. Occasionally, emboli traverse from the pulmonary to the systemic cir...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2024-03-01
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| Series: | JBJS Open Access |
| Online Access: | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.23.00128 |
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| author | Steinar Kristiansen, MD Anders Hagen Jarmund, MSc Jonas Hilmo, MD Tom Eirik Mollnes, MD, PhD Martin Leth-Olsen, MD Siri Ann Nyrnes, MD, PhD Bent Aksel Nilsen, RN Renathe Henriksen Grønli, MSc Bjørn Ove Faldaas, MSc Benjamin Storm, MD, PhD Arild Espenes, DVM, PhD Erik Waage Nielsen, MD, PhD |
| author_facet | Steinar Kristiansen, MD Anders Hagen Jarmund, MSc Jonas Hilmo, MD Tom Eirik Mollnes, MD, PhD Martin Leth-Olsen, MD Siri Ann Nyrnes, MD, PhD Bent Aksel Nilsen, RN Renathe Henriksen Grønli, MSc Bjørn Ove Faldaas, MSc Benjamin Storm, MD, PhD Arild Espenes, DVM, PhD Erik Waage Nielsen, MD, PhD |
| author_sort | Steinar Kristiansen, MD |
| collection | DOAJ |
| description | Background:. Shaft fractures of the femur are commonly treated with intramedullary nailing, which can release bone marrow emboli into the bloodstream. Emboli can travel to the lungs, impairing gas exchange and causing inflammation. Occasionally, emboli traverse from the pulmonary to the systemic circulation, hindering perfusion and resulting in injuries such as heart and brain infarctions, known as fat embolism syndrome. We studied the extent of systemic bone marrow embolization in a pig model.
Methods:. Twelve anesthetized pigs underwent bilateral intramedullary nailing of the femur, while 3 animals served as sham controls. Monitoring included transesophageal echocardiography (TEE), pulse oximetry, electrocardiography, arterial blood pressure measurement, and blood gas and troponin-I analysis. After surgery, animals were monitored for 240 minutes before euthanasia. Post mortem, the heart, lungs, and brain were biopsied.
Results:. Bone marrow emboli were found in the heart and lungs of all 12 of the pigs that underwent intramedullary nailing and in the brains of 11 of them. No emboli were found in the sham group. The pigs subjected to intramedullary nailing exhibited significant hypoxia (PaO2/FiO2 ratio, 410 mm Hg [95% confidence interval (CI), 310 to 510) compared with the sham group (594 mm Hg [95% CI, 528 to 660]). The nailing group exhibited ST-segment alterations consistent with myocardial ischemia and a significant increase in the troponin-I level compared with the sham group (1,580 ng/L [95% CI, 0 to 3,456] versus 241 ng/L [95% CI, 0 to 625] at the 240-minute time point; p = 0.005). TEE detected emboli in the right ventricular outflow tract, but not systemically, in the nailing group.
Conclusions:. Bilateral intramedullary nailing caused bone marrow emboli in the lungs and systemic emboli in the heart and brain in this pig model. The observed clinical manifestations were consistent with coronary and pulmonary emboli. TEE detected pulmonary but not systemic embolization.
Clinical Relevance:. Femoral intramedullary nailing in humans is likely to result in embolization as described in our pig model. Focused monitoring is necessary for detection of fat embolism syndrome. Absence of visual emboli in the left ventricle on TEE does not exclude the occurrence of systemic bone marrow emboli. |
| first_indexed | 2024-03-07T20:00:49Z |
| format | Article |
| id | doaj.art-23eb4d85ba3f436887141d877585bc51 |
| institution | Directory Open Access Journal |
| issn | 2472-7245 |
| language | English |
| last_indexed | 2024-04-24T18:49:17Z |
| publishDate | 2024-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | JBJS Open Access |
| spelling | doaj.art-23eb4d85ba3f436887141d877585bc512024-03-27T03:42:16ZengWolters KluwerJBJS Open Access2472-72452024-03-019110.2106/JBJS.OA.23.00128JBJSOA2300128Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and BrainSteinar Kristiansen, MD0Anders Hagen Jarmund, MSc1Jonas Hilmo, MD2Tom Eirik Mollnes, MD, PhD3Martin Leth-Olsen, MD4Siri Ann Nyrnes, MD, PhD5Bent Aksel Nilsen, RN6Renathe Henriksen Grønli, MSc7Bjørn Ove Faldaas, MSc8Benjamin Storm, MD, PhD9Arild Espenes, DVM, PhD10Erik Waage Nielsen, MD, PhD111 Department of Surgery, Nordland Hospital, Bodø, Norway3 Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway1 Department of Surgery, Nordland Hospital, Bodø, Norway4 Research Laboratory, Nordland Hospital, Bodø, Norway3 Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway3 Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway1 Department of Surgery, Nordland Hospital, Bodø, Norway4 Research Laboratory, Nordland Hospital, Bodø, Norway3 Department of Circulation and Medical Imaging (ISB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway1 Department of Surgery, Nordland Hospital, Bodø, Norway8 Department of Basic Sciences and Aquatic Medicine, Norwegian School of Veterinary Science, Oslo, Norway1 Department of Surgery, Nordland Hospital, Bodø, NorwayBackground:. Shaft fractures of the femur are commonly treated with intramedullary nailing, which can release bone marrow emboli into the bloodstream. Emboli can travel to the lungs, impairing gas exchange and causing inflammation. Occasionally, emboli traverse from the pulmonary to the systemic circulation, hindering perfusion and resulting in injuries such as heart and brain infarctions, known as fat embolism syndrome. We studied the extent of systemic bone marrow embolization in a pig model. Methods:. Twelve anesthetized pigs underwent bilateral intramedullary nailing of the femur, while 3 animals served as sham controls. Monitoring included transesophageal echocardiography (TEE), pulse oximetry, electrocardiography, arterial blood pressure measurement, and blood gas and troponin-I analysis. After surgery, animals were monitored for 240 minutes before euthanasia. Post mortem, the heart, lungs, and brain were biopsied. Results:. Bone marrow emboli were found in the heart and lungs of all 12 of the pigs that underwent intramedullary nailing and in the brains of 11 of them. No emboli were found in the sham group. The pigs subjected to intramedullary nailing exhibited significant hypoxia (PaO2/FiO2 ratio, 410 mm Hg [95% confidence interval (CI), 310 to 510) compared with the sham group (594 mm Hg [95% CI, 528 to 660]). The nailing group exhibited ST-segment alterations consistent with myocardial ischemia and a significant increase in the troponin-I level compared with the sham group (1,580 ng/L [95% CI, 0 to 3,456] versus 241 ng/L [95% CI, 0 to 625] at the 240-minute time point; p = 0.005). TEE detected emboli in the right ventricular outflow tract, but not systemically, in the nailing group. Conclusions:. Bilateral intramedullary nailing caused bone marrow emboli in the lungs and systemic emboli in the heart and brain in this pig model. The observed clinical manifestations were consistent with coronary and pulmonary emboli. TEE detected pulmonary but not systemic embolization. Clinical Relevance:. Femoral intramedullary nailing in humans is likely to result in embolization as described in our pig model. Focused monitoring is necessary for detection of fat embolism syndrome. Absence of visual emboli in the left ventricle on TEE does not exclude the occurrence of systemic bone marrow emboli.http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.23.00128 |
| spellingShingle | Steinar Kristiansen, MD Anders Hagen Jarmund, MSc Jonas Hilmo, MD Tom Eirik Mollnes, MD, PhD Martin Leth-Olsen, MD Siri Ann Nyrnes, MD, PhD Bent Aksel Nilsen, RN Renathe Henriksen Grønli, MSc Bjørn Ove Faldaas, MSc Benjamin Storm, MD, PhD Arild Espenes, DVM, PhD Erik Waage Nielsen, MD, PhD Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain JBJS Open Access |
| title | Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain |
| title_full | Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain |
| title_fullStr | Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain |
| title_full_unstemmed | Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain |
| title_short | Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain |
| title_sort | femoral nailing in a porcine model causes bone marrow emboli in the lungs and systemic emboli in the heart and brain |
| url | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.23.00128 |
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