Reducing Risk of Fat Embolism During Interlocking Nail Femur Surgery
Pathophysiology and Risk
- Early surgical stabilization of femoral shaft fractures within 24 hours of injury is strongly recommended to prevent fat embolism syndrome and ARDS, according to the American Society of Anesthesiologists 1
- Fat embolism syndrome can occur during procedures that breach the femoral canal, such as intramedullary nailing, and is a concern in patients undergoing femur surgery 2
Surgical Techniques to Reduce Fat Embolism Risk
- Thoroughly washing and drying the femoral canal before cement or prosthesis insertion can help reduce the risk of fat embolism, as recommended by the American Academy of Orthopaedic Surgeons 3, 4
- Using a pressurized lavage system to clean endosteal bone of fat and marrow contents can help reduce the risk of fat embolism 3, 2
- Avoiding excessive manual pressurization in high-risk patients can help reduce the risk of fat embolism, according to the American Heart Association 3
- Inserting cement from a gun in retrograde fashion on top of the plug can help reduce the risk of fat embolism 4
- Pulling the suction catheter out as soon as it is blocked with cement can help reduce the risk of fat embolism 3
- Avoiding vigorous pressurization of cement in patients at risk of cardiovascular compromise can help reduce the risk of fat embolism 4
Anesthetic Considerations
- Ensuring adequate hydration before induction of and during anesthesia can help reduce the risk of fat embolism, as recommended by the American Society of Anesthesiologists 3
- Maintaining systolic blood pressure within 20% of pre-induction values throughout surgery can help reduce the risk of fat embolism 3, 4
- Increasing inspired oxygen concentration during critical moments of the procedure can help reduce the risk of fat embolism 5
Post-operative Considerations
- Administering supplemental oxygen for at least 24 hours postoperatively can help reduce the risk of fat embolism, according to the American Thoracic Society 5