[Post-traumatic fat embolism. Apropos of 272 French cases]

Pulmonary migration of fat globules form a fracture, although anatomically very frequent, rarely gives rise to clinical signs or symptoms. This pathological and clinical entity of fat embolism following trauma, remained for long undiagnosed in France, as the first published cases date from 1949 only; the syndrome is not, however, exceptional for, since 1949, 272 cases have been described including 42 which are published here. Clinical fat embolism affects, above all, adults with fracture of the femoral diaphysis placed in continuous extension. Continuous extension ensures only imperfect immobilisation and permits liberation of fat emboli from the focus whenever the patient moves. Early osteosynthesis is a generally effective means of prevention. The pathogenesis of fat embolism is still debated. It seems that in all cases the clinical signs are due to toxicity of fatty acids liberated from fat emboli. The usual acute neuro-respiratory form occurs after a free interval and associates four groups of symptoms: fever, dyspnea, coma and purpura. There exist forms with mainly neurological or respiratory symptoms, together with mild forms which may raise difficult diagnostic problems. Numerous further examinations have been proposed to permit this diagnosos. One should emphasize, in particular, the fundamental importance of abnormalities of the fundus oculi. The prognosis, which was very poor a few years ago, has been considerably improved with progress in resuscitation based mainly on maintenance of artificial respiration throughout the critical phase which is about 8 to 10 days. Further progress is, however, still possible for there is still a definite mortality.