Quote from: KirP1 on April 20, 2015, 10:56:42 PMwhy do you think this patient death? i readed the report, but cant remember. it was fat embolism?
Yep.
[Strategy in the surgical treatment of achondroplasia: techniques applied in the Department of Orthopedics and Traumatology Hospital of Lecco]
M.A. Catagni, F. Guerreschi, L. Lovisetti
Between 1982 and 2007, 128 patients with achondroplasia were treated in the Lecco Hospital. 100 of these were treated with sequential bilateral limb lengthening and seven with crossed lengthening. The average tibial lengthening was 14.1 centimeters (range: 6 to 19 cm). The average femoral lengthening was 9.8 centimeters (range: 8 to 12 cm), and the average humeral lengthening 8.3 centimeters (range: 8 to 12 cm).
...
The complications were classified as minor, moderate, and severe. Minor complications were those which required only modification of the apparatus during treatment. Twenty-three percent of the lengthenings required some modification of the device during treatment. Moderate complications were those which required additional procedures during lengthening. Forty-two percent of patients fell into this category. Finally, severe complications were those which required another surgery following treatment or had lasting sequelae of the treatment. Twenty-one percent of patients fell into this category. The most common complication was equinus contractures of the ankle which required treatment by tendoachilles lengthening. Two pulmonary emboli were sustained following percutaneous tendo-achilles lengthening. One patient died as a result of this complication.
http://link.springer.com/article/10.1007%2Fs10261-009-0032-9
[Fat embolism during limb lengthening with a centromedullary nail: three cases].
Blondel B1, Violas P, Launay F, Sales de Gauzy J, Kohler R, Jouve JL, Bollini G.
Several methods are available for progressive limb lengthening, including centromedullary nailing, external fixation, or a combination. Each technique has its own advantages and drawbacks. In trauma victims, use of centromedullary nailing is associated with potentially fatal fat embolism. This fatal outcome might also occur during limb lengthening, particularly in bilateral procedures. To our knowledge, fat embolism has not been reported with the use of centromedullary nail for limb lengthening. This was a multicentric study of three cases of fat embolism, including one fatal outcome. In all, 36 centromedullary lengthening nails were inserted in the three centers before these acute episodes. The first two cases occurred during single-phase bilateral procedures, the third during unilateral lengthening.
Fat embolism could result from several factors, as reported in the literature. While the bilateral nature of the procedure has been incriminated, the observation of an embolism during a unilateral procedure suggests other factors may be involved. Considerable increase in endomedullary pressure during reaming and insertion of the nail has been demonstrated. At the same time, there is the question as to whether the reduction of the diminution of medullary pressure by corticotomy would be an efficient way of reducing the risk of fat embolism. Based on the analysis of our three cases, we suggest that the best way to avoid fat embolism might be to drill several holes within the area of the osteotomy before reaming, in order to reduce endomedullary pressure. This can be achieved via a short skin incision, sparing the periosteum before low energy osteotomy. Since applying this protocol, the three centers have implanted 17 lengthening nails, without a single case of fat embolism.
http://www.ncbi.nlm.nih.gov/pubmed/18774027
