CARDIOVASCULAR COLLAPSE AFTER FEMORAL PROSTHESIS SURGERY FOR ACUTE HIP FRACTURE

Purpose: Prosthetic revision of hip fractures may result in embolizati on of tissue products leading to death. In this report, from cases rep orted to the Anaesthesia Advisory Committee to the Chief Coroner of On tario, emphasis is placed on the immediate resuscitative procedures wh ich may offset a fatal outcome. Clinical features: Two elderly patient s are reported in whom hip fractures necessitated primary prosthetic h ip repair, The first patient, with a history of limited cardiac reserv e and syncope, suffered a subcapital hip fracture. Under general anaes thesia, a Moore's prosthesis was inserted, The anaesthetic period rema ined relatively stable until surgical reaming of the femoral canal, Br adycardia, hypotension and cyanosis developed and quickly proceeded to a fatal arrest, Autopsy demonstrated diffuse pulmonary embolism of fa t and thrombus. The second patient suffered fracture around the stem o f a previously inserted femoral prosthesis, Under general aesthesia, a new cemented hip prosthesis was inserted, following which hypotension occurred. This was supported with small doses ephedrine, ventilation was controlled with oxygen and the procedure was quickly terminated. D espite addition of a dopamine infusion, cardiac arrest and death follo wed. Autopsy disclosed massive fat and bone marrow embolization. Concl usion: The combination of hip fracture, activated clotting factors and borderline cardiopulmonary function presents a risk of death from emb olization of tissue products released during the placement of a cement ed hip prosthesis, While the outcome of this catastrophe is generally poor, all practitioners should be prepared to immediately institute re suscitative procedures to manage the accompanying cardiovascular colla pse.