An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?

dc.contributor.advisorKruger, Nicholasen_ZA
dc.contributor.authorMcCollum, Grahamen_ZA
dc.date.accessioned2015-03-13T14:10:59Z
dc.date.available2015-03-13T14:10:59Z
dc.date.issued2010en_ZA
dc.descriptionIncludes bibliographical references.en_ZA
dc.description.abstractFirst introduced by Kuntshner, femoral nailing has become the 'Gold Standard' of treatment for femur fractures. The efficacy and benefit of early osteosynthesis by this technique is well established. Some of the acute complications of intramedullary manipulation and nailing are fat embolism syndrome, pulmonary dysfunction and Adult Respiratory Distress Syndrome (ARDS). One of the causes of fat embolism is a raised intramedullary pressure. Investigators have shown the direct correlation of intramedullary pressure with fat intravesation and embolism in both animal and human studies. Fat embolism syndrome is unpredictable and the true incidence is unknown. Mortality from fat embolism syndrome ranges from 10-35%. The incidence is increased with associated pulmonary trauma and in the multiply injured patient. The aim of our study was to investigate the intramedullary pressure rise during reamed prograde femoral nailing and determine whether fracture level and complexity affect the peak pressures. The relevance is that certain fracture types or levels that result in the highest pressures can be identified before the operation. Measures could be taken to reduce the intramedullary pressure during the procedure, particularly in those patients at greatest risk of pulmonary complications from fat embolism. We hypothesised that more proximal, simple fractures generate higher pressures during nailing because there is a long 'closed tube' distal to the fracture. Pressure proximal to the fracture does not reach the same high levels because the intra-medullary content is able to decompress through the fracture as the reamer moves distally. With proximal fractures there is a greater volume of medullary content distal to the fracture which can enter the venous system and embolize. Fracture comminution and complexity should lead to lower intramedullary pressures because there is a greater length of the femur through which the intramedullary content can decompress. The study sought to answer the question of whether fracture level makes a difference with respect to the intramedullary pressure rise during reamed prograde nailing. The results of this study have not been submitted for publication at the time of submission of these results for the thesis.en_ZA
dc.identifier.apacitationMcCollum, G. (2010). <i>An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences. Retrieved from http://hdl.handle.net/11427/12605en_ZA
dc.identifier.chicagocitationMcCollum, Graham. <i>"An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences, 2010. http://hdl.handle.net/11427/12605en_ZA
dc.identifier.citationMcCollum, G. 2010. An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - McCollum, Graham AB - First introduced by Kuntshner, femoral nailing has become the 'Gold Standard' of treatment for femur fractures. The efficacy and benefit of early osteosynthesis by this technique is well established. Some of the acute complications of intramedullary manipulation and nailing are fat embolism syndrome, pulmonary dysfunction and Adult Respiratory Distress Syndrome (ARDS). One of the causes of fat embolism is a raised intramedullary pressure. Investigators have shown the direct correlation of intramedullary pressure with fat intravesation and embolism in both animal and human studies. Fat embolism syndrome is unpredictable and the true incidence is unknown. Mortality from fat embolism syndrome ranges from 10-35%. The incidence is increased with associated pulmonary trauma and in the multiply injured patient. The aim of our study was to investigate the intramedullary pressure rise during reamed prograde femoral nailing and determine whether fracture level and complexity affect the peak pressures. The relevance is that certain fracture types or levels that result in the highest pressures can be identified before the operation. Measures could be taken to reduce the intramedullary pressure during the procedure, particularly in those patients at greatest risk of pulmonary complications from fat embolism. We hypothesised that more proximal, simple fractures generate higher pressures during nailing because there is a long 'closed tube' distal to the fracture. Pressure proximal to the fracture does not reach the same high levels because the intra-medullary content is able to decompress through the fracture as the reamer moves distally. With proximal fractures there is a greater volume of medullary content distal to the fracture which can enter the venous system and embolize. Fracture comminution and complexity should lead to lower intramedullary pressures because there is a greater length of the femur through which the intramedullary content can decompress. The study sought to answer the question of whether fracture level makes a difference with respect to the intramedullary pressure rise during reamed prograde nailing. The results of this study have not been submitted for publication at the time of submission of these results for the thesis. DA - 2010 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2010 T1 - An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure? TI - An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure? UR - http://hdl.handle.net/11427/12605 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/12605
dc.identifier.vancouvercitationMcCollum G. An investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Health and Rehabilitation Sciences, 2010 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/12605en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Health and Rehabilitation Sciencesen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherOrthopaedic Surgeryen_ZA
dc.titleAn investigation into the intramedullary pressure rise during femoral nailing: does the level and type of fracture determine peak pressures during the procedure?en_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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