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dc.contributor.authorKristiansen, Steinar
dc.contributor.authorJarmund, Anders Hagen
dc.contributor.authorHilmo, Jonas Larsen
dc.contributor.authorMollnes, Tom Eirik
dc.contributor.authorLeth-Olsen, Martin
dc.contributor.authorNyrnes, Siri Ann
dc.contributor.authorNilsen, Bent Aksel
dc.contributor.authorGrønli, Renathe Henriksen
dc.contributor.authorFaldaas, Bjørn Ove
dc.contributor.authorStorm, Benjamin Stage
dc.contributor.authorEspenes, Arild
dc.contributor.authorNielsen, Erik Waage
dc.date.accessioned2024-05-24T11:19:38Z
dc.date.available2024-05-24T11:19:38Z
dc.date.issued2024-02-28
dc.description.abstractBackground: 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.<p> <p>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. <p>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. <p>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. <p>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.en_US
dc.identifier.citationKristiansen, Jarmund, Hilmo, Mollnes, Leth-Olsen, Nyrnes, Nilsen, Grønli, Faldaas, Storm, Espenes, Nielsen. Femoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brain. JBJS Open Access. 2024;9(1)en_US
dc.identifier.cristinIDFRIDAID 2254753
dc.identifier.doi10.2106/JBJS.OA.23.00128
dc.identifier.issn2472-7245
dc.identifier.urihttps://hdl.handle.net/10037/33606
dc.language.isoengen_US
dc.publisherLippincotten_US
dc.relation.journalJBJS Open Access
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2024 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)en_US
dc.titleFemoral Nailing in a Porcine Model Causes Bone Marrow Emboli in the Lungs and Systemic Emboli in the Heart and Brainen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)