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Canadian Journal of Anaesthesia

, Volume 44, Issue 2, pp 198–201 | Cite as

Cardiovascular collapse after femoral prosthesis surgery for acute hip fracture

  • Stanley Pietak
  • John Holmes
  • Raymond Matthews
  • Anthony Petrasek
  • Bonita Porter
Clinical Report

Abstract

Purpose

Prosthetic revision of hip fractures may result in embolization of tissue products leading to death. In this report, from cases reported to the Anaesthesia Advisory Committee to the Chief Coroner of Ontario, emphasis is placed on the immediate resuscitative procedures which may offset a fatal outcome.

Clinical features

Two elderly patients are reported in whom hip fractures necessitated primary prosthetic hip repair. The first patient, with a history of limited cardiac reserve and syncope, suffered a subcapital hip fracture. Under general anaesthesia, a Moore’s prosthesis was inserted. The anaesthetic penod remained relatively stable until surgical teaming of the femoral canal. Bradycardia. hypotension and cyanosis developed and quickly proceeded to a fatal cardiac anest. Autopsy demonstrated diffuse pulmonary embolism of fat and thrombus. The second patient suffered a fracture around the stem of a previously inserted femoral prosthesis. Under general anaesthesia, a new cemented hip prosthesis was inserted, following which hypotension occurred. This was supported with small doses of ephednne, ventilation was controlled with oxygen and the procedure was quickly terminated. Despite addition of a dopamme infusion, cardiac arrest and death followed. Autopsy disclosed massive fat and bone marrow embolization.

Conclusion

The combination of hip fracture, activated clotting factors and borderline cardiopulmonary function presents a risk of death from embolization of tissue products released during the placement of a cemented hip prosthesis. While the outcome of this catastrophe is generally poor, all practitioner’s should be prepared to immediately institute resuscitative procedures to manage the accompanying cardiovascular collapse.

Keywords

Femoral Canal Tissue Product Resuscitative Procedure Chief Coroner Marrow Embolism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Objectif

Les révisions de fractures de la hanche peuvent provoquer des embolies tissulaires fatales. Dans ce compte rendu, rédigé à partir de cas soumis au comité aviseur en anesthésie du coroner en chef de l’Ontano, on souligne l’importance de l’instauration immédiate de mesures de réanimation susceptibles de prévenir un dénouement fatal.

Éléments cliniques

Le cas de deux patients âgés chez qui des fractures de la hanche ont nécessité une réduction ouverte avec prothèse est rapporté. Le premier patient qui avait une histoire de réserve cardiaque diminuée et de syncope, avait subi une fracture sous-capitale du fémur. Sous anesthésie générale, une prothèse de Moore a été insérée. Uanesthésie est demeurée relativement stable jusqu’à l’alésage de la fracture. Une bradycardie. de l’hypotension et de la cyanose sont apparues et ont rapidement évolué vers l’arrêt cardiaque. L’autopsie a montré des embolies diffuses de graisse et des thrombi. Le second patient a subi une fracture sur une tige de prothèse préalablement implantée. Sous anesthésie générale, l’insertion d’une nouvelle prothèse cimentée de la hanche a provoqué une chute de pression. De petites doses d’éphédnne ont été administrées, la ventilation a été contrôlée, de l’oxygène administré et l’intervention terminée rapidement. Malgré l’ajout d’une perfusion de dopamime, un arrêt cardiaque et le décès ont suivi. Lautopsie a démontré une embolisation massive de graisse et de moelle osseuse.

Conclusion

L’association de fracture de la hanche, de facteurs de coagulation activés et d’une fonction cardiopulmonaire limite présente un risque de mortalité accru par embolisation de tissu libéré pendant le mise en place d’une prothèse cimentée de la hanche. Bien que le pronostic de cette catastrophe soit généralement mauvais, tous les intervenants devraient être prêts à appliquer les mesures usuelles de réanimation immédiates pour prendre en charge le collapsus cardiovasculaire concomitant.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Stanley Pietak
    • 1
  • John Holmes
    • 2
  • Raymond Matthews
    • 1
  • Anthony Petrasek
    • 3
  • Bonita Porter
    • 4
  1. 1.Departments of AnaesthesiaQueen’s UniversityKingston
  2. 2.Peterborough Civic HospitalToronto
  3. 3.St. Joseph’s Health CentreToronto
  4. 4.Chief Coroner’s OfficeToronto

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