Abstract
This study was designed to investigate whether intramedullary pressure and embolization of bone marrow fat are different in unreamed compared with conventional reamed femoral nailing in vivo. In a baboon model, the femoral shaft was stabilized with interlocking nailing after a midshaft osteotomy. Intramedullary pressure was measured in the distal femoral shaft fragment at the supracondylar region. Extravasation of bone marrow fat was determined by the modified Gurd test (range: 0–5) with blood samples from the vena cava inferior. Data were monitored in eight unreamed and eight reamed intramedullary femoral nailing procedures. Intramedullary pressure increased in the unreamed group to 76 ± 25 mm Hg (10.1 ± 3.3 kPa) during insertion of 7‐mm nails and in the reamed group to 879 ± 44 mm Hg (117.2 ± 5.9 kPa) during reaming of the medullary cavity. Insertion of 9‐mm nails after the medullary cavity had been reamed to 10 mm produced an intramedullary pressure of 254 ± 94 mm Hg (33.9 ± 12.5 kPa) (p < 0.05). Fat extravasation in the unreamed group was recorded with a score of 2.9 ± 0.4 for the Gurd test during nailing with 7‐mm nails, whereas in the reamed group significantly more fat extravasation was noticed during the reaming procedures, with a score of 4.6 ± 0.1. Liberation of fat during insertion of 9‐mm nails after reaming was recorded with a score of 3.5 ± 0.4. In both groups, a positive correlation of fat extravasation with the rise in intramedullary pressure was found (reamed group: r~s~ = 0.868: unreamed group: r~s~ = 0.698), resulting in significantly less liberation of bone marrow fat in the unreamed stabilized group than in the reamed control group (p < 0.05). The data indicate that fat embolization during nailing procedures after femoral osteotomy increases with increasing intramedullary pressure and occurs in a lesser degree in unreamed than in reamed intramedullary femoral shaft stabilization.