Transoesophageal Echocardiography for the Detection and Prevention of Embolic Episodes during Intramedullary Nailing for Pathological Fractures

Abstract

We performed transoesophageal echocardiography on 22 patients during intramedullary nailing for pathological fractures. Moderate quantities of echogenic signals as a rosary in the screen of TEE (D = 1 mm) were observed in 10 patients during the opening of the bone marrow. Embolic episodes as a snowball (D = 1 -5 mm) were observed in all patients during the intramedullary reaming and the introduction of the nail. The haemodynamic changes were related with the duration of the embolism. Two patients developed haemodynamic disorders, treated with 100 % O₂ and vasoconstrictors. Seven patients developed transient but not significant changes of arterial pressure, SaO₂ and P_ECO_2. Paradoxical embolisation or fat embolism syndrome were observed in no patients. In one of these patients a flow-patent foramen ovale was detected preoperatively. During the operation and after intravenous fluid loading the right to left shunt flow could not be detected. This may represent a mechanism whereby paradoxical embolisation could be prevented intraoperatively. Transoesophageal echocardiography in intramedullary nailing for pathological fractures may play a useful role in the recording and anaesthesiological treatment of embolic episodes, venous and paradoxical, during these operations.

Pathological fractures - intramedullary nailing - transoesophageal echocardiography

References

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