Fat embolism – An update

Fat embolism syndrome: What have we learned over the years?

Although its original clinical description dates from the nineteenth century, fat embolism syndrome remains a diagnostic challenge for clinicians. Fat emboli occur in all patients with long-bone fractures, but only few of them develop a multisystem disorder affecting the lung, brain, and skin, also known as fat embolism syndrome (FES). The incidence of FES varies and is often underestimated. Mechanical and biochemical theories have been proposed for the pathophysiology of FES. Clinical manifestations consist of respiratory and cerebral dysfunction and a petechial rash. Diagnosis of FES is difficult and based mainly on clinical criteria. FES is a self-limiting disease and treatment needs to be mainly supportive. Surgical treatment of the coexistent injuries is still obscured by controversies and the treatment methods used provide inconclusive results. In this context, prevention focuses on the early identification of predisposing factors.

Surgical Stabilization of Femur Fractures in Post-Traumatic Hypoxemic Patients: When and Why?

Background:

Post-traumatic hypoxemia can deteriorate during operative manipulations.

Objectives:

In the present study, criteria-based approach was applied to determine optimum conditions for femur surgery. The aim of this study was to optimize perioperative management of post-traumatic hypoxemia.

Patients and Methods:

In this prospective observational study, post-traumatic adults with PaO₂ < 70 mmHg in room air were enrolled. Physiological parameters, O₂ saturation (SO₂), arterial blood gas (ABG) analysis, Schonfeld fat embolism index score (SS), and Murray’s lung injury scores (LIS) were assessed. The management protocol was femur surgery when patient was hemodynamically stable with LIS < 2.5 and PaO₂/FiO₂ > 200 mmHg (FiO₂ < 0.5, PEEP < 8 cm H₂O).

Results:

A total of 31 adults (26 males and 5 females) with LIS of 0.1 to 2.5 (26 patients) and > 2.5 (five patients) at admission were recruited. Sixteen patients were admitted within 24 hours and 15 between 24 and 90 hours after injury. Thirteen patients were operated within 24 hours. Post-operative LIS was improved. No adverse sequels or mortality were seen.

Conclusions:

Appropriate surgical stabilization can be safely performed during established post-traumatic hypoxemia using a multidisciplinary approach, continuous monitoring, and serial investigations to diagnose fulminant pathology and associated injuries.