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Updated: May 29, 2026

A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration
Published on: February 27, 2018
Cerebral fat emboli: a trigger of post-operative delirium
George Cox1, Christopher Tzioupis, Giorgio Maria Calori
1Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK.
Abstract:
Accumulating evidence implicates cerebral fat embolism (CFE) as a causative agent in post-operative confusion (POC). CFE occurs following orthopaedic procedures including, intra-medullary (IM) nailing and total joint arthroplasty (TJA). The incidence of CFE is high (59-100% TJA) and the resulting POC is associated with higher overall complication rates. Cognitive dysfunction improves in many patients but can persist - with potentially disastrous outcomes. The pathomechanics of CFE implicate circulating lipid micro-emboli (LME) that are forced from IM depots by instrumentation/nailing. Passage to the left side of the heart is possible through intra-cardiac or arteriovenous shunts in the lung. LME are propelled to the brain where they cause disruption via ischemia or by alterations in the blood-brain-barrier - causing cerebral oedema. Prevention of CFE follows established practices for preventing FES and consideration of additional techniques to remove resident fat and reduce IM pressures. When CFE occurs supportive treatment should be established.
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