Fat embolism and death during prophylactic osteosynthesis of a metastatic femur using an unreamed femoral nail

RE Peter, A Schopfer, B Le Coultre… - Journal of orthopaedic …, 1997 - journals.lww.com
RE Peter, A Schopfer, B Le Coultre, P Hoffmeyer
Journal of orthopaedic trauma, 1997journals.lww.com
We report a case of cardiovascular collapse and death occuring intraoperatively during the
prophylactic nailing of a metastatic femur using an unreamed femoral nail. The cause of
death, as documented by the autopsy, was a massive fat embolism. The risk of fat embolism
while performing intramedullary nailing is well known and has been linked to the process of
medullary reaming. Unreamed femoral interlocking nails recently have become available.
Although recent reports in the literature have concluded that the risk of fat embolism appears …
Abstract
We report a case of cardiovascular collapse and death occuring intraoperatively during the prophylactic nailing of a metastatic femur using an unreamed femoral nail. The cause of death, as documented by the autopsy, was a massive fat embolism. The risk of fat embolism while performing intramedullary nailing is well known and has been linked to the process of medullary reaming. Unreamed femoral interlocking nails recently have become available. Although recent reports in the literature have concluded that the risk of fat embolism appears less likely while using unreamed implants, the surgeon should carefully consider the indications for any type of intramedullary fixation, particularly when dealing with unbroken femurs exhibiting impending pathologic fracture, or when preexisting pulmonary disease such as metastasis is present.
Lippincott Williams & Wilkins
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