Novel Venting Technique for Intramedullary Rod Fixation of Pathologic Fractures

Prophylactic intramedullary fi xation of impending pathologic fractures is an important preventative technique. Intramedullary rods provide longitudinal structural support, protecting weakened cortices from fracture displacement, providing pain relief, and allowing for restoration of function.1,2 In the femur, prophylactic stabilization of an impending fracture in a metastatic tumor population has demonstrated decreased hospital stays and improved likelihood of support-free ambulation.3 The intramedullary fi xation of an intact bone is usually technically easier, but carries some potential procedural risks. Reports in the literature have shown severe pulmonary and cardiovascular dysfunction as a result of marrow embolization from the reaming and instrumentation of an intact femur.4,5 This embolic phenomenon has been reported in the arthroplasty literature with intramedullary access for femoral stems.6,7 While canal entry is associated with an intramedullary pressure spike, the reaming of the canal also increases intramedullary pressures causing bone marrow to extravasate into the venous circulation.8 Venting an intact femur prior to prophylactic instrumentation has been previously demonstrated to reduce this phenomenon.9 This venting may decrease embolic load, especially if active collection of the extravasated bone marrow contents is performed. This article presents a simple and novel solution requiring minimal additional equipment to vent the distal femur during intramedullary reaming and potentially decrease the embolic load.