High Intramedullary Pressures Research Articles

Fat intravasation, fat emboli and fat embolism syndrome in adult major trauma patients with intraosseous catheters: a systematic review

IntroductionIntraosseous (IO) administration of medication, fluids and blood products is accepted practice for critically injured patients in whom intravenous access is not immediately available. However, there are concerns that high...

Cement arteriovenogram after hip arthroplasty

Modern cement implantation techniques during hip arthroplasty rely on high intramedullary pressures which can result in cement extrusion towards femoral nutrient vessels, and thus, the occurrence of a particular image in postoperative radiographs (bone cement arterio-venogram).We report a case series of 14 patients in whom a bone cement arterio-venogram was observed after undergoing a cemented hip arthroplasty. No local or systemic complications developed after cementing nor during a mean follow-up of three years.Bone cement arterio-venogram is a radiologic sign that indicates a good cement pressurisation during surgery and is not associated to medical complications or periprosthetic femoral fractures.

Arteriovenograma de cemento óseo en artroplastia de cadera

Modern cement implantation techniques during hip arthroplasty rely on high intramedullary pressures which can result in cement extrusion towards femoral nutrient vessels, and thus, the occurrence of a particular image in postoperative radiographs (bone cement arterio-venogram).We report a case series of 14 patients in whom a bone cement arterio-venogram was observed after undergoing a cemented hip arthroplasty. No local or systemic complications developed after cementing nor during a mean follow-up of three years.Bone cement arterio-venogram is a radiologic sign that indicates a good cement pressurisation during surgery and is not associated to medical complications or periprosthetic femoral fractures.

Enhancing Proximal Femoral Pressure during Cemented Stem Insertion

Poor proximal femoral pressures during a cemented primary hip replacement may compromise proximal fixation and cause early aseptic loosening. Occlusion of the calcar, during stem insertion, achieves a uniform and sustained rise in the proximal intra-medullary pressure, which should enhance cement penetration into bone and improve long-term survival of the prosthesis. 54 Exeter stems were cemented into femoral moulds prepared from plaster of Paris. Pressure transducers were connected to the proximal, middle and distal zones of the mould. After cement insertion, stems were implanted with occlusion of the calcar by either nothing, a thumb placed medially or an Exeter horse-collar. 18 stems each were inserted into Palacos-R at 3½-4 minutes and 4-4½ minutes after mixing and Simplex-P 6-6½ minutes after mixing and the intra-medullary pressures were measured. Data were subjected to regression analysis using SPSS. Proximal and distal intra-medullary pressures were significantly higher (P < 0.01-0.001) with proximal occlusion in all cements. The highest pressures were achieved with Palacos-R at 4-4½ minutes after mixing, with proximal thumb occlusion. Stem insertion into Palacos-R at 3½-4 min. or 4-4½ min. after mixing, gave higher pressures than into Simplex-P regardless of the method of occlusion. With Simplex-P, there was a trend to higher proximal intra-medullary pressures with the horse-collar. Occluding the calcar during stem insertion into cement achieves and sustains high intra-medullary pressures in both the proximal and distal femur. The highest pressures are obtained with stem insertion into Palacos-R at 4-4½ minutes after mixing, with proximal thumb occlusion. A horse-collar achieves slightly higher pressures with Simplex-P.

What Is Wrong in the Cava? A Rare Cause of Deep Vein Thrombosis

When using cement in a hip arthroplasty, high intramedullary pressures are generated. This may lead to several complications, ranging from local extravasation to systemic complications such as the implantation syndrome. Until now, venous migration of cement after hip arthroplasty has never been associated with morbidity or mortality. We present a case in which cement pressurization led to migration of cement up to the level of the inferior vena cava with subsequent deep vein thrombosis.

Intramedullary Canal Pressure Distribution: An Experimental Parametric Study

Intramedullary instrument/device insertion during total joint replacement can generate high intramedullary pressures, with potential for clinical fat embolism syndrome. We evaluated effects of process parameters on intramedullary pressure generated when hammering an implant into a simulated femur analogue. Lower implant insertion speed, lower hammering force, a rubber- compared with steel-tipped hammer and a larger synthetic bone-to-implant radial gap reduced intramedullary pressure generated. Number of hammer strikes required to insert an implant increased with increasing marrow viscosity, whereas intramedullary pressure decreased with increasing viscosity. Significant intramedullary pressure reduction is obtained by applying more strikes of lower peak force using a rubber hammer tip, as opposed to fewer larger strikes. Caution should be exercised when instrumenting the distal femur, where viscosity is low and very high intramedullary pressures can be generated.

Intravenous polymethyl methacrylate after cemented hemiarthroplasty of the hip

Current cementing techniques used during hip arthroplasty aim to maximize the bond at the bone-cement interface in an effort to increase the longevity of the prosthesis. To accomplish this, one must generate high intramedullary pressures, which are known to be associated with complications such as cement implantation syndrome. We record a rare complication following cement pressurization of a hip hemiarthroplasty that resulted in intravenous polymethyl methacrylate (PMMA). This complication however, is not associated with a significant morbidity or mortality, but it is important to identify and distinguish from a femoral cortical defect, which can be created during surgery.

Surgical emphysema formation during intramedullary reaming of a humerus

Intramedullary nailing is an accepted method of treatment for pathological fractures of a humerus [ 1 Crolla R.M.P.H. de Vries L.S. Clevers G.J. Locked intramedullary nailing of humeral fractures. Injury. 1993; 24: 403-406 Abstract Full Text PDF PubMed Scopus (67) Google Scholar , 2 Harrington K.D. Orthopaedic management of extremity and pelvic lesions. Clin. Orthop. 1995; 312: 136-147 PubMed Google Scholar ].

Fatal marrow embolization following a porous-coated bipolar hip endoprosthesis

Fat embolization syndrome is a well-known complication associated with total hip arthroplasty. It is believed to be caused by high intramedullary pressures that occur during cement pressurization and femoral stem placement. Fat embolization syndrome has also been reported with intramedullary reaming and placement of an intramedullary alignment guide during total knee arthroplasty. To our knowledge, there have not been previous reports of fatal fat emboli as a result of uncemented hip arthroplasty. The purpose of this case report is to describe a fatality due to fat embolization following a noncemented bipolar arthroplasty.

Cardiopulmonary function and pulmonary microemboli during arthroplasty using cemented or non-cemented components. The role of intramedullary pressure.

An experimental model was designed to investigate the role of intramedullary pressure on cardiopulmonary function and pulmonary pathology during arthroplasty using cemented and non-cemented components. Twenty-four dogs were divided randomly into three groups: a group that received a non-cemented implant in which low intramedullary pressure was generated, a group that received a cemented implant, and one that received bone wax and an implant; high intramedullary pressures were generated in the latter two groups. Bone wax was used to generate high intramedullary pressures without the use of bone cement. In the group with the non-cemented implant, few pulmonary microemboli and no significant cardiorespiratory changes were found. In the groups that received bone wax and an implant or the cemented implant, there were many pulmonary microemboli and significant cardiorespiratory changes, including decreased arterial oxygen tension, increased pulmonary arterial pressure, and increased intrapulmonary shunt fraction. There was no evidence that methylmethacrylate monomer was responsible for the cardiorespiratory changes in the group with the cemented implant.

The intramedullary pressure during the bone marrow trauma of total hip replacement surgery.

It is known that complications occur frequently in connection with extensive intramedullary operative procedures. The destruction of the medullary circulation is followed by a partial cortical necrosis, which certainly will diminish if the intramedullary pressure during the operation is reduced. There are also general complications with cardio-pulmonary dysfunction possibly caused by pulmonary fat embolism. The same types of complication are likely to occur in connection with total hip replacement surgery, especially during the femoral phase of the operation. In this study it was found that very high intramedullary pressures were always produced when the prosthetic stem was forced down into the femoral cavity filled with acrylic cement, while the duration of the pressure elevations after this procedure showed greater variation. The importance of the high intramedullary pressures for the extent of devascularization and cortical necrosis is discussed, as well as its possible role as an aetiologk factor in the development of general complications such as fat embolism and sudden circulatory crises.