Background Instrumentation, particularly reaming, of the long bones carries the risk of embolic phenomenon. Emboli may result in pulmonary injury, which is usually manifested by desaturation. This pulmonary injury may be particularly relevant if there is diminished pulmonary reserve due to pre-existing lung disease such as lung carcinoma. In extreme cases, this can result in cardiac arrest intraoperatively.

Patients and methods We reviewed 34 consecutive operations that involved instrumentation of long bones for metastases of lung carcinoma.

Results Desaturation developed during 1 procedure, and there was hypotension in 5 patients. In addition, cardiac arrest occurred intraoperatively in 1 patient, which was the only fatality.

Interpretation This study has shown that while emboli during femoral instrumentation may be common, significant clinical manifestations of this phenomenon are uncommon.