What can be done to prevent fat embolization to the chest and the brain?

Many investigators have provided excellent reports which examine the effect of reamer design. A Reamer / Irrigator / Aspirator (RIA) has been introduced (Image 1) which permits single pass reaming with intramedullary suction/irrigation to reduce the intramedullary pressure.

Reamer / Irrigator / Aspirator (RIA) - Davos 4/1/97

 Reamer Type  IM Pressure
 without vacuum irrigation

 347 mm Hg

 with vacuum irrigation

 64 mm Hg

Work from Davos shows a dramatic reduction in the pressure with the vacuum-irrigation system.

Besides modifying the reamer and the reaming technique, Ross Leighton has done some excellent work on venting the femur and reducing intramedullary pressure.