OBJECTIVE: To measure the amount of fat presented to the right heart during reaming and nail placement using two different reamer systems. DESIGN: Prospective, randomized clinical trial. SETTING:University-based Level I Trauma Center. PATIENTS: 20 patients with femur fractures. INTERVENTION: Patients with femur fractures were treated with intramedullary nailing using either reamer-irrigator-aspirator or a conventional reamer. MAIN OUTCOME MEASURE: four-chamber trans-esophageal echocardiogram was used to quantify the amount of fat presented to the right atrium. RESULTS: There were 2 female and 18 male patients enrolled, 10 in each group. There was no significant difference (p = 0.10) between reaming systems on the opening reamer, which was expected since both trial limbs used the same opening reamer. However, during the first pass of the reamer, the RIA showed a nearly-significant decrease in the volume of fat in the right atrium (p = 0.06). During passage of the nail, there was a significant difference with Group B having less fat embolus than Group A (p = 0.01). The power of this study is 0.81. The mean ISS was not significantly different between the two groups, nor was the sex, age or race. There was one death from cardiac complications in a patient who showed no fat during any phase of the procedure. This patient had significant mitral and aortic regurgitation pre-operatively. There was one patient with clinical fat embolism syndrome and one patient with a nonunion. CONCLUSIONS: There is a statistically significant difference in the amount of fat presented to the lungs using a RIA versus conventional reamer.
RCT Entities:
OBJECTIVE: To measure the amount of fat presented to the right heart during reaming and nail placement using two different reamer systems. DESIGN: Prospective, randomized clinical trial. SETTING: University-based Level I Trauma Center. PATIENTS: 20 patients with femur fractures. INTERVENTION: Patients with femur fractures were treated with intramedullary nailing using either reamer-irrigator-aspirator or a conventional reamer. MAIN OUTCOME MEASURE: four-chamber trans-esophageal echocardiogram was used to quantify the amount of fat presented to the right atrium. RESULTS: There were 2 female and 18 male patients enrolled, 10 in each group. There was no significant difference (p = 0.10) between reaming systems on the opening reamer, which was expected since both trial limbs used the same opening reamer. However, during the first pass of the reamer, the RIA showed a nearly-significant decrease in the volume of fat in the right atrium (p = 0.06). During passage of the nail, there was a significant difference with Group B having less fat embolus than Group A (p = 0.01). The power of this study is 0.81. The mean ISS was not significantly different between the two groups, nor was the sex, age or race. There was one death from cardiac complications in a patient who showed no fat during any phase of the procedure. This patient had significant mitral and aortic regurgitation pre-operatively. There was one patient with clinical fat embolism syndrome and one patient with a nonunion. CONCLUSIONS: There is a statistically significant difference in the amount of fat presented to the lungs using a RIA versus conventional reamer.
Authors: Robin Hall Dunn; Trevor Jackson; Clay Cothren Burlew; Fredric M Pieracci; Charles Fox; Mitchell Cohen; Eric M Campion; Ryan Lawless; Cyril Mauffrey Journal: Int Orthop Date: 2017-05-30 Impact factor: 3.075
Authors: Markus Laubach; Lucas P Weimer; Felix M Bläsius; Frank Hildebrand; Philipp Kobbe; Dietmar W Hutmacher Journal: Arch Orthop Trauma Surg Date: 2022-09-17 Impact factor: 2.928
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