A Study of the Pathway of Marrow Fat Intravasation during Intramedullary Reaming

Abstract

Marrow fat intravasation is common after intramedullary reaming. However, the pathway of marrow fat entering into the systemic circulation has not been completely documented. The present study was designed to study the pathway of marrow fat intravasation during intramedullary reaming and the related clinical implications with an animal model. Five goats were subjected to intramedullary reaming and 3 goats received skin incisions as control. Real-time changes of intramedullary pressure were measured during reaming. Osseous and pulmonary tissues were studied histologically at the end of the experiment. The intramedullary pressure reached 565 ± 198 mmHg at the first reaming. Marrow fats were found inside the Haversian canals, Volkmann canals, osteocytic lacunae, periosteal vessels, extraosseous vessels and pulmonary circulation in all animals with reaming. In contrast to the common belief that marrow fat directly goes to the vascular system from the marrow cavity, this study documents the pathway of marrow fat intravasation via intracortical canaliculi. This finding could explain the pathogenesis of pulmonary fat embolism after reaming of a non-fractured intramedullary canal.

Key words

Marrow fats - Haversian canal - Volkmann canal - osteocytic lacunae - periosteal vessel - pulmonary circulation

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