DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20222279
Published: 2022-08-29

Fat embolism syndrome: a case series and review of literature

Aamir Shafi, Tahir Ashraf Kar, Asif Bashir Thoker, Aariba Zahoor

Abstract


Fat embolism and fat embolism syndrome (FES) is a clinical spectrum characterized by dissemination of fat emboli into the systematic circulation usually as a result of orthopedic trauma and related surgical procedures. we present a case series of three patients who had FES of variable presentation and severity. In our first case patient initially developed FES pre operatively which was complicated by acute pulmonary thromboembolism in the post operative period. In our third case patient developed FES after intra medullary nail fixation of femoral shaft fracture. Fat embolism is relatively rare but fatal complication in orthopedic trauma and during long bone fracture manipulations. In addition, fat embolism is a risk factor for pulmonary thromboembolism as was evident in our first case. So, patients of fat embolism should be closely monitored for the later. Gurd and Wilson are the most commonly used criteria for the diagnosis of FES. Treatment is largely supportive and some preventive measures include early fixation of long bone fractures. Prophylactic use of steroids in a meta-analysis has been found to prevent occurrence of FES in nearly two third of patients. There is no proven role of hypertonic dextrose infusion, heparin or corticosteroids in the treatment of FES and therefore are not routinely recommended. In case of fulminant FES steroids should be considered.


Keywords


Fat embolism syndrome, Long bone fracture, Gurd and Wilson criteria

Full Text:

PDF

References


Talbot M, Schemitsch EH. Fat embolism syndrome: history, definition, epidemiology. Injury. 2006; 37(4):S3-7.

Fabian TC, Hoots AV, Stanford DS, Patterson CR, Mangiante EC. Fat embolism syndrome: Prospective evaluation in 92 fracture patients. Crit Care Med. 1990;18:42-6.

Stein PD, Yaekoub AY, Matta F, Kleerekoper M. Fat embolism syndrome. Am J Med Sci. 2008;336:472-7.

Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome. A 10-year review. Arch Surg. 1997;132:435-9.

Fukumoto LE, Fukumoto KD. Fat Embolism Syndrome. Nurs Clin North Am. 2018;53(3):335-47.

Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome. A 10-year review. Arch Surg. 1997;132:435-9.

Eriksson EA, Pellegrini DC, Vanderkolk WE, Minshall CT, Fakhry SM, Cohle SD. Incidence of pulmonary fat embolism at autopsy: an undiagnosed epidemic. J Trauma. 2011;71:312-5.

Scarpino M, Lanzo G, Lolli F, Grippo A. From the diagnosis to the therapeutic management: cerebral fat embolism, a clinical challenge. Int J Gen Med. 2019;12:39-48.

Shaikh N, Mahmood Z, Ghuori SI, Chanda A, Ganaw A, Zeeshan Q, Ehfeda M, Mohamed Belkhair AO, Zubair M, Kazi ST, Momin U. Correlation of clinical parameters with imaging findings to confirm the diagnosis of fat embolism syndrome. Int J Burns Trauma. 2018;8(5):135-44.

Riska EB, Myllynen P. Fat embolism in patients with multiple injuries. J Trauma. 1982;22:891-4.

llardyce DB, Meek RN, Woodruff B, Cassim MM, Ellis D. Increasing our knowledge of the pathogenesis of fat embolism: A prospective study of 43 patients with fractured femoral shafts. J Trauma. 1974;14:955-62.

Wong MW, Tsui HF, Yung SH, Chan KM, Cheng JC. Continuous pulse oximeter monitoring for inapparent hypoxemia after long bone fractures. J Trauma. 2004;56:356-62.

Olivera Arencibia Y, Vo M, Kinaga J, Uribe J, Velasquez G, Madruga M, Carlan SJ. Fat Embolism and Nonconvulsive Status Epilepticus. Case Rep Neurol Med. 2018;5057624.

Kao SJ, Yeh DY, Chen HI. Clinical and pathological features of fat embolism with acute respiratory distress syndrome. Clin Sci (Lond). 2007;113:279-85.

Smith AL. What Is the Best E&M of Fat Embolism Syndrome? Hospitalist. 2012;8.

Scotton WJ, Kohler K, Babar J, Russell-Hermanns D, Chilvers ER. Fat embolism syndrome with Purtscher’s retinopathy. Am J Respir Crit Care Med. 2013;187:106.

Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br. 1970;52:732-7.

Ong SC, Balasingam V. Characteristic imaging findings in pulmonary fat embolism syndrome (FES). Case Rep. 2017;bcr-2017.

Dwivedi S, Kimmel LA, Kirk A, Varma D. Radiological features of pulmonary fat embolism in trauma patients: a case series. Emerg Radiol. 2022;29(1):41-7.

Piolanti M, Dalpiaz G, Scaglione M, Coniglio C, Miceli M, Violini S, Trisolini R, Barozzi L. Fat embolism syndrome: lung computed tomography findings in 18 patients. J Comp Assisted Tomography. 2016;40(3):335-42.

Ryu CW, Lee DH, Kim TK, Kim SJ, Kim HS, Lee JH, et al. Cerebral fat embolism: diffusion-weighted magnetic resonance imaging findings. Acta Radiol. 2005;46:528-33.

Webb DP, McKamie WA, Pietsch JB. Resuscitation of fat embolism syndrome with extracorporeal membrane oxygenation. J Extra Corpor Technol. 2004;36:368-70.

Husebye EE, Lyberg T, Røise O. Bone marrow fat in the circulation: clinical entities and pathophysiological mechanisms. Injury. 2006;37(4):S8-18.

Simon AD, Ulmer JL, Strottmann JM. Contrast-enhanced MR imaging of cerebral fat embolism: case report and review of the literature. Am J Neuroradiol. 2003;24(1):97-101.

Prakash S, Sen RK, Tripathy SK, Sen IM, Sharma RR, Sharma S. Role of interleukin-6 as an early marker of fat embolism syndrome: a clinical study. Clin Orthop Relat Res. 2013;471:2340-6.

Bederman SS, Bhandari M, McKee MD, Schemitsch EH. Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis. Can J Surg. 2009;52:386-93.

Bederman SS, Bhandari M, McKee MD, Schemitsch EH. Do corticosteroids reduce the risk of fat embolism syndrome in patients with long-bone fractures? A meta-analysis. Canad J Surg. 2009;52(5):386.

Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg Am. 1989;71:336-40.

Pape HC. Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: damage control orthopedic surgery. J Orthop Res. 2008;26(11):1478-84.

Habashi NM, Andrews PL, Scalea TM. Therapeutic aspects of fat embolism syndrome. Injury. 2006;37(4):S68-73.

Kellogg RG, Fontes RB, Lopes DK. Massive cerebral involvement in fat embolism syndrome and intracranial pressure management. J Neurosurg. 2013;119:1263-70.

Berlot G, Bussani R, Shafiei V, Zarrillo N. Fulminant Cerebral Fat Embolism: Case Description and Review of the Literature. Case Rep Crit Care. 2018;7813175.