Intramedullary Pressure Increase and Increase in Cortical Temperature During Reaming of the Femoral Medullary Cavity: The Effect of Draining the Medullary Contents before Reaming
- 1 September 2003
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal Of Trauma-Injury Infection and Critical Care
- Vol. 55 (3), 495-503
- https://doi.org/10.1097/01.ta.0000075919.53201.7d
Abstract
Reaming is regarded as the most adverse aspect of the intramedullary nailing procedure since it leads not only to impairment of the vessels but also to an increase in intramedullary pressure and cortical temperatures which may in turn lead to aseptic cortical necroses and pulmonary dysfunction. Intramedullary pressure increase is considered to be the most detrimental of these factors. The aim of this study was to investigate the effect on intramedullary pressure and cortical temperature of removing the medullary fat before reaming. The fat was removed through a suction tube inserted proximally. The measurements were made on pairs of human femora whereby in one group the contents of the medulla were drained by suction before reaming. The pressure was measured in the mid diaphysis and in the metaphysis. The temperature was measured in the mid diaphysis. The femora were reamed in a water bath at 37 degrees C and at a constant insertion force. In comparison to the group which was not drained, the pressure for the 9.0 mm reamer in previously drained femora was reduced as follows: positive diaphyseal pressure by 88% (reamer insertion); positive metaphyseal pressure by 78% (reamer insertion); negative diaphyseal pressure by 84% (reamer withdrawal); negative metaphyseal pressure by 65% (reamer withdrawal). No significant difference was determined for temperature increase (median suction, 39.7 degrees C; median without suction, 39.4 degrees C). The removal of the medullary contents by suction before inserting reaming instruments leads to a considerable and statistically significant pressure reduction. If the medullary contents are not sucked out before reaming or insertion of unreamed nails, high intramedullary pressure and the risk of embolization is unaltered. Consequently new instruments should be developed to facilitate the removal of the medullary contents before commencing the reaming procedure or insertion of unreamed nails.Keywords
This publication has 11 references indexed in Scilit:
- Technical Innovations in Medullary Reaming: Reamer Design and Intramedullary Pressure IncreaseJournal Of Trauma-Injury Infection and Critical Care, 2000
- Can Modifications to Reamer and Flexible Shaft Design Decrease Intramedullary Pressure during Reaming? An Experimental InvestigationTechniques in Orthopaedics, 1996
- Transcardiac echocardiography during invasive intramedullary proceduresThe Journal of Bone and Joint Surgery. British volume, 1995
- Pathogenesis and clinical relevance of bone marrow embolism in medullary nailing — demonstrated by intraoperative echocardiographyInjury, 1993
- Intramedullary pressure in reamed and unreamed nailing of the femur and tibia — an in vitro study in intact, human bonesInjury, 1993
- Influence of the compression force on the intramedullary pressure development in reaming of the femoral medullary cavityInjury, 1993
- Intramedullary pressure, strain on the diaphysis and increase in cortical temperature when reaming the femoral medullary cavity — a comparison of blunt and sharp reamersInjury, 1993
- Measurement of intramedullary pressure in an animal experiment and propositions to reduce the pressure increaseInjury, 1993
- Internal fixation of fractures by intramedullary nailing introduction, historical review and present statusInjury, 1993
- Intramedullary Nailing after Reaming: An Investigation on the Healing Process in Osteotomized Rabbit TibiasActa Orthopaedica, 1970