Fat embolism among patients with hip and long bone fractures in Albania

The aim of this study was to assess the incidence and the effectiveness of treatment of fat embolism in patients with hip and long bone fractures (femur and tibia) in Albania.

229 patients (68% men) with combined hip and long bone fractures (femur and tibia) hospitalized at the Orthopedics-Traumatology Services of the University Center "Mother Teresa" during 2004-2006 were included in the study. Patients were classified into three groups based on astrupogram data: PaO2<60mmHg, 65mmHg75mmHg. Chi square test was used to compare fracture differences between men and women and the effectiveness of combined use of metilprednisolon and anticoagulants vs. anticoagulants alone.

Poly traumas combined with femur fracture were more frequent in 2005. These combined poly traumas combined were more frequent among men than women (P<0.001). Remarkably, femur fractures were more frequent among men than women (9:1). Coli femur fractures peaked in the age-group 76-85 years. In general, poly traumas were less frequent in the older age groups, with a peak between 36-55 years, being more frequent among men, but the difference was not statistically significant. Fractures of coli femur and those of tibia were more frequent in 2006, while in 2004 femur fractures were more frequent. In almost all age groups fractures of coli femur were more frequent, followed by fractures of femur and tibia. In general, poly traumas were more frequent among men than women, ranging from 6:1 for fractures of femur to 2:1 for tibia fractures. The incidence of fat embolism ranged from 4.9% to 8.9% for the period 2004-2006. Among fat embolism patients, 100% of them had tachycardia, 88.2% had petechia, 84% tachipnea, 23.5% cyanosis and blood sputum, and 41.2% obnubilation. In general, during 2004-2006 the frequency of combined use of metilprednisolon and anticoagulants has increased.

Clinical diagnosis remains the most important element for the detection of fat embolism syndrome. The incidence of fat embolism was 8-9 times higher than the rates reported in literature. This finding is linked with trauma gravity in Albania. Combined use of metilprednisolon with anticoagulants seems to be more effective than use of anticoagulants alone in preventing fat embolism (P<0.05) and patients using the combined therapy have experienced milder forms of disease. Therefore, the combined treatment should be preferred over the single treatment for the prevention of fat embolism.