Cerebral microemboli during hip fracture fixation: A prospective study

BACKGROUND: Recent studies have shown that cerebral fat microembolism takes place during surgery for hip or knee replacement. In this study, we examined the occurrence of cerebral microembolism, solid or gas, during a standard procedure of hip fracture fixation. METHODS: This was a prospective study of patients who underwent urgent surgery with a dynamic hip screw for hip fracture fixation. During surgery, patients were monitored with transcranial Doppler for detection of microemboli from right and left middle cerebral arteries. RESULTS: Twenty-two patients were included in the study; their median age was 82 yr (range, 51-97 yr). In nine (41%) patients, high intensity transient signals were recorded, indicating microemboli passage in the middle cerebral arteries. All nine patients had signals of both solid and gas emboli. One of these nine patients had a postoperative cerebrovascular accident. CONCLUSIONS: The incidence of cerebral microemboli during urgent surgery for hip fracture fixation is considerable. This phenomenon is not confined to hip or knee replacement surgery. The clinical implications of this finding require further investigation.