Fat Emboli Syndrome in a Child with Duchenne Muscular Dystrophy After Minor Trauma

Fat embolism syndrome in Duchenne muscular dystrophy: Report on a novel case and systematic literature review

We report a non-ambulatory 13-year-old boy with Duchenne muscular dystrophy who experienced severe acute respiratory distress syndrome and cerebral fat embolism following elective soft tissue surgery. Post-surgery radiological examination revealed bilateral femoral fractures and marked osteopenia that were believed to have caused disseminated pulmonary and cerebral fat embolism. The patient had never been on glucocorticoid treatment. Five months post-surgery, he remained in a state of minimal consciousness. A literature review was performed and eleven publications included, providing case reports of a total number of 23 patients with Duchenne muscular dystrophy with fat embolism syndrome. The most common causes were falls from the wheelchair that predominantly resulted in femoral fractures. Median age at the event was around 14 years. Seven patients succumbed to complications of fat embolism. No event was described in the context of surgery. We want to raise awareness that spontaneous unnoticed fractures may occur especially in adolescents with DMD from traumatic injury of large bones and also during elective surgery with a high risk of causing fat embolism with severe sequelae.

Clinical Reasoning: Patient With Prior Spinal Cord Injury Who Developed Altered Mental Status After a Fall

An 18-year-old man with a history of complete traumatic spinal cord injury (SCI) at C5-C7 3 years before presented with unresponsiveness and hypoxia after a fall. There were no overt signs of bruising or swelling. After extensive and unrevealing initial workup, MRI brain without contrast showed numerous diffusely scattered punctate foci of diffusion restriction and evidence of numerous microhemorrhages. A full body skeletal survey revealed mildly affected, nondisplaced, incomplete fractures in the distal femoral metaphyses bilaterally. This case presentation discusses specific considerations for patients with SCI, reviewing the differential diagnosis, workup, and management of altered mental status after minor falls or other trauma in this population.

The Musculoskeletal Aspects of Obesity in Neuromuscular Conditions

Obesity is a common problem in children and adolescents with neuromuscular disease. The available literature on obesity in cerebral palsy, spina bifida, and Duchenne muscular dystrophy as it relates to orthopedic treatment is reviewed, including the demographics and measurement of obesity as well as the mechanisms of obesity in these individuals. In addition, the effect of obesity on function, patient evaluation, and orthopedic treatment are reviewed.

Fat embolism after fractures in Duchenne muscular dystrophy: an underdiagnosed complication? A systematic review

Duchenne muscular dystrophy is the most frequent lethal genetic disease. Several clinical trials have established both the beneficial effect of steroids in Duchenne muscular dystrophy and the well-known risk of side effects associated with their daily use. For many years it has been known that steroids associated with ambulation loss lead to obesity and also damage the bone structure resulting in the bone density reduction and increased incidence of bone fractures and fat embolism syndrome, an underdiagnosed complication after fractures. Fat embolism syndrome is characterized by consciousness disturbance, respiratory failure and skin rashes. The use of steroids in Duchenne muscular dystrophy may result in vertebral fractures, even without previous trauma. Approximately 25% of patients with Duchenne muscular dystrophy have a long bone fracture, and 1% to 22% of fractures have a chance to develop fat embolism syndrome. As the patients with Duchenne muscular dystrophy have progressive cardiac and respiratory muscle dysfunction, the fat embolism may be unnoticed clinically and may result in increased risk of death and major complications. Different treatments and prevention measures of fat embolism have been proposed; however, so far, there is no efficient therapy. The prevention, early diagnosis and adequate symptomatic treatment are of paramount importance. The fat embolism syndrome should always be considered in patients with Duchenne muscular dystrophy presenting with fractures, or an unexplained and sudden worsening of respiratory and cardiac symptoms.