THE DETECTION OF FAT-EMBOLISM BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY DURING REAMED INTRAMEDULLARY NAILING - A STUDY OF 24 PATIENTS WITH FEMORAL AND TIBIAL FRACTURES

We performed transoesophageal echocardiography on 24 patients during r eamed intramedullary nailing of 17 tibial and seven femoral fractures. In 14 patients there was only minimal evidence of emboli passing thro ugh the heart, but in six copious showers of small emboli (< 10 mm max imum dimension) were observed. In four other patients, there were also multiple large emboli (> 10 mm maximum dimension). Three of these pat ients developed fat embolism syndrome postoperatively and one died. Ea rlier nailing was associated with smaller quantities of emboli.