I was having lunch with a person today and she mentioned that her father had suffered Cardiac Arrest after a fracture of his femur. Something to do with seepage of bone marrow…I find myself sceptical. Not that cardiac arrest happened (he was resuscitated) but that the femur was itself the cause. She is not a doctor nor am I.
IANAD, but I seem to recall that’s how Finny died in “A Seperate Peace.”
Such a break can cause a fat embolism, which can cause death by blocking cardiac, pulmonary etc vessels.
http://www.medterms.com/script/main/art.asp?articlekey=116363
I think there was something in House where the issue was a broken bone “leaking” bone marrow. Not that House necessarily proves anything.
Yes, fat embolism, as noted by IvoryTowerDenizen. It’s a well-known potential complication of femur fractures. It even gets mentioned in a MASH episode.
Wasn’t that what happened to Finny in A Separate Peace?
Fat embolism is possiblity. If your friend specifically mentioned “seepage of bone marrow,” that is probably what she was referring to. Do you know if it was definitively diagnosed with an autopsy? Per my experience as a medical examiner, confirmed FE as a cause of death is really a zebra. Far far more common is just that the system gets sufficiently strained by the fracture that moderate or even mild preexisting comrbidities, such as heart disease, become significant enough that in combination with the injury they cause “cardiac arrest,” which after al is really just a synonym for death.
I hope not. The OP noted the patient was resuscitated.
I seem to recall a character dying from something like that in a novel I read in high school.
Could that possibly have what killed Howie Morenz?
As I understand it, Mel Blanc fell out of his hospital bed (they forgot to put up the rails) and broke his femur. He died from it. (Go to YouTube, type in Mel Blanc, his bio is in there.)
This is what killed a Formula One driver.
Political commentator and author Jeff Greenfield used it to kill off President-elect Foyle in his novel The People’s Choice.
Also, a broken femur can subject a person to death by volume shock, no?
Ignorance fought! Thanks. Follow up. Why is the femur though? Is it because of the reletive size of the bone.
Biggest bone in the body, biggest marrow cavity in the body (except maybe for the pelvis, which doesn’t fracture and misalign so readily), with large veins right around it which can be gashed open by the bone shards and provide easy entrance to the vascular system for a fatty marrow embolism.
Actually, no fat embolism need be involved. Trauma that involves blood loss can potentially cause cardiac arrest. For example, suicide by wrist slashing often are ultimately caused by cardiac arrest induced by major blood loss.
But unless it’s an open femoral fracture, it’ll usually tamponade itself. There’s just not that much space to bleed into in the upper thigh. Leave a huge bruise, yes. Critical volume of blood lost? Maybe, maybe not.
Here’s a few notes about fat embolism syndrome from UpToDate, a subscription medical website:
Just to provide final context, a large portion of our bone marrow is fat, especially as adults. That’s where the “fat embolus” comes from. It’s actually quite remarkable–in any orthopedic surgery that involves reaming out bones (e.g. hip replacements), the fluid that results looks like someone mixed melted butter into blood.
As an aside, Qadgop, do you find UptoDate useful? I have an awkward subscription through my remote-access to my hospital’s intranet, but I’m thinking of paying the $300 or whatever to get full access at home/on my phone. Would you recommend it? I remember liking it as a clerk, but I’m not sure how much I’ll use it as a resident.
I recommend it highly. It’s enhanced my practice greatly, streamlining things and keeping me on top of important updates. It doesn’t waste my time with the latest studies, which have not really yet been incorporated into practice standards because there’s not been enough time yet to decide if the latest ‘breakthrough’ is meaningful or not. It tells me what standard practices are, and tells me when they change.