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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 4/2024

Open Access 17-02-2024 | Orthopaedic Surgery

In vivo study to assess fat embolism resulting from the Reamer-Irrigator-Aspirator 2 system compared to a novel aspirator-based concept for intramedullary bone graft harvesting

Authors: Markus Laubach, Agathe Bessot, Siamak Saifzadeh, Flavia Medeiros Savi, Frank Hildebrand, Nathalie Bock, Dietmar W. Hutmacher, Jacqui McGovern

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 4/2024

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Abstract

Introduction

Fat embolism (FE) following intramedullary (IM) reaming can cause severe pulmonary complications and sudden death. Recently, a new harvesting concept was introduced in which a novel aspirator is used first for bone marrow (BM) aspiration and then for subsequent aspiration of morselized endosteal bone during sequential reaming (A + R + A). In contrast to the established Reamer-Irrigator-Aspirator (RIA) 2 system, the new A + R + A concept allows for the evacuation of fatty BM prior to reaming. In this study, we hypothesized that the risk of FE, associated coagulopathic reactions and pulmonary FE would be comparable between the RIA 2 system and the A + R + A concept.

Materials and methods

Intramedullary bone graft was harvested from intact femora of 16 Merino sheep (age: 1–2 years) with either the RIA 2 system (n = 8) or the A + R + A concept (n = 8). Fat intravasation was monitored with the Gurd test, coagulopathic response with D-dimer blood level concentration and pulmonary FE with histological evaluation of the lungs.

Results

The total number and average size of intravasated fat particles was similar between groups (p = 0.13 and p = 0.98, respectively). D-dimer concentration did not significantly increase within 4 h after completion of surgery (RIA 2: p = 0.82; A + R + A: p = 0.23), with an interaction effect similar between groups (p = 0.65). The average lung area covered with fat globules was similar between groups (p = 0.17).

Conclusions

The use of the RIA 2 system and the novel A + R + A harvesting concept which consists of BM evacuation followed by sequential IM reaming and aspiration of endosteal bone, resulted in only minor fat intravasation, coagulopathic reactions and pulmonary FE, with no significant differences between the groups. Our results, therefore, suggest that both the RIA 2 system and the new A + R + A concept are comparable technologies in terms of FE-related complications.
Appendix
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Metadata
Title
In vivo study to assess fat embolism resulting from the Reamer-Irrigator-Aspirator 2 system compared to a novel aspirator-based concept for intramedullary bone graft harvesting
Authors
Markus Laubach
Agathe Bessot
Siamak Saifzadeh
Flavia Medeiros Savi
Frank Hildebrand
Nathalie Bock
Dietmar W. Hutmacher
Jacqui McGovern
Publication date
17-02-2024
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 4/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-024-05220-w

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