Monitoring and controlling intramedullary pressure increase in long bone instrumentation: a study on sheep

Intramedullary reamed nailing causes elevation in intramedullary pressure and extravazation of intramedullary contents into the venous blood system. This study investigated the effect of an intramedullary suction system, recently developed in our laboratory, on the pressure and fat extravazation in isolated bovine bone and a sheep model. During reaming, the pressure with and without suction was recorded at each step of the procedure. Hemodynamic parameters of mean arterial blood pressure, pulmonary artery pressure, pulmonary arterial CO(2) (PaCO(2)), heart rate, and oxygen saturation were monitored. Blood and lung tissue samples were collected for the examination of medullary fat intravazation. The increases of intramedullary pressure were dramatically reduced in the suction group (p < 0.05) in both in vitro and in vivo experiments. PaCO(2) was significantly lower in the suction group than nonsuction group (32 vs. 40 mmHg, respectively, p = 0.02), while oxygen saturation was higher in the suction group (99 vs. 91 mmHg, respectively, p = 0.009). Histological data revealed a significant higher count of fat emboli in sheep lung tissue in the nonsuction group. Total lipids in lung specimens was lower in the suction group (7.6 mg/g tissue) than in the nonsuction group (13.6 mg/g, p = 0.04). The suction system appears to control the surge in intramedullary pressure and therefore prevent fat embolism.