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Femoral shaft – Antegrade nailing – fat embolization during reaming

Pitfall 4: Rapid thrusting/systemic fat embolization
Care should be taken to use sharp reamers, to advance the reamers slowly, and to allow sufficient time between reaming steps for the intramedullary pressure to normalize. Rapid thrusting of the reamer may worsen the intramedullary pressure increase that is observed during nailing. This image demonstrates fat extrusion in a human cadaver specimen with a window in the proximal section.