What can cause a fat emboli during IM nailing?

What can cause a fat emboli during IM nailing?

• A. Reaming
• B. External fixation
• C. Plate insertion
• D. Injection of local anesthetic

Answer: (A)

During intramedullary nailing, reaming the medullary canal raises intramedullary pressure dramatically. That high pressure can push fat from the yellow marrow, along with marrow debris and even small amounts of air, into the venous system via the canal’s venous channels. Once these fat globules enter the venous circulation, they can embolize to the lungs, causing a fat embolism, and in some cases reach other organs. The other steps—external fixation, plate insertion, or injecting local anesthetic—do not involve opening or pressurizing the intramedullary canal to the same extent, so they are not typical sources of fat emboli during this procedure.

During intramedullary nailing, reaming the medullary canal raises intramedullary pressure dramatically. That high pressure can push fat from the yellow marrow, along with marrow debris and even small amounts of air, into the venous system via the canal’s venous channels. Once these fat globules enter the venous circulation, they can embolize to the lungs, causing a fat embolism, and in some cases reach other organs. The other steps—external fixation, plate insertion, or injecting local anesthetic—do not involve opening or pressurizing the intramedullary canal to the same extent, so they are not typical sources of fat emboli during this procedure.