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A Preclinical Controlled Cortical Impact Model for Traumatic Hemorrhage Contusion and Neuroinflammation
Published on: June 10, 2020
Cerebral emboli and cognitive function after intramedullary fracture fixation
Andrew C Gray1, Lorna Torrens, James Christie
1Department of Orthopaedics and Trauma, Edinburgh Royal Infirmary, 15 Little France, Edinburgh, UK. andrewgray@doctors.o
Injury
|April 21, 2009
Summary
Intramedullary nailing for lower limb fractures produced few cerebral emboli, with no significant impact on cognitive function. This finding aligns with studies in arthroplasty and cardiac surgery, suggesting low emboli levels rarely cause clinical effects.
Area of Science:
- Orthopaedic Surgery
- Neuroscience
- Vascular Surgery
Background:
- Cerebral emboli are detected during intramedullary orthopaedic procedures.
- The quantity and clinical effects of these emboli are not well understood.
- This study investigates cerebral embolic load during femoral and tibial fracture fixation.
Purpose of the Study:
- Quantify intra-operative cerebral embolic load using transcranial Doppler ultrasound.
- Assess post-operative clinical cognitive function.
- Determine the relationship between cerebral embolic load and cognitive function.
Main Methods:
- Prospective cohort study of 20 patients undergoing reamed intramedullary nailing for diaphyseal fractures.
- Cerebral embolic load measured via transcranial Doppler ultrasound of the middle meningeal artery.
- Cognitive function assessed using validated neuropsychological tests 3 days post-surgery.
Main Results:
- Four patients had detectable cerebral emboli (counts 2-9).
- A significant decline in immediate and delayed memory recall was observed.
- No significant difference in cognitive function was found between patients with and without detectable emboli.
Conclusions:
- Low numbers of cerebral emboli occur during intramedullary stabilization of lower limb fractures.
- No apparent cognitive effect was associated with these emboli.
- Findings are consistent with studies in arthroplasty and cardiac surgery, indicating low systemic embolization unlikely to cause clinical cerebral effects.
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