Fat embolism: the reaming controversy

  • Giannoudis P
  • Tzioupis C
  • Pape H
  • 40


    Mendeley users who have this article in their library.
  • 53


    Citations of this article.


Intramedullary nailing is the preferred treatment method for stabilizing femoral diaphyseal fractures. Despite its superior biomechanical advantages over other implants, its use, particularly in selected groups of patients, has been questioned because of the possible harmful systemic effects of intramedullary reaming. The increase in intramedullary canal pressure during intramedullary nailing can result in intravasation of bone marrow and fat into the venous blood system. The subsequent consequences can be fat embolism syndrome (FES), adult respiratory distress syndrome (ARDS), and multiple organ failure. The lung seems to be the primary target for fat embolization and for the mediated effects primed by inflammatory reactions. In laboratory studies, both reamed and unreamed intramedullary nailing has been shown to alter selected pulmonary variables. Although transient, this effect appears to be more prominent with reamed than unreamed techniques. Additional studies are required to determine whether a subgroup of trauma patients is adversely affected by intramedullary reaming, thus necessitating other fixation techniques. © 2006.

Author-supplied keywords

  • Adult respiratory distress syndrome (ARDS)
  • Fat embolism
  • Intramedullary nailing
  • Multiple organ dysfunction syndrome (MODS)
  • Reaming

Get free article suggestions today

Mendeley saves you time finding and organizing research

Sign up here
Already have an account ?Sign in

Find this document


  • Peter V. Giannoudis

  • Christopher Tzioupis

  • Hans Christoph Pape

Cite this document

Choose a citation style from the tabs below

Save time finding and organizing research with Mendeley

Sign up for free