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Fatal Cerebral Fat Embolism After Pelvic and Multiple Long Bone Fractures without Associated Lung Injury: A Case
William J Hadden1, Brent Herritt2, Richard Hoang2
1Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Case:
A 29-year-old motor vehicle collision passenger presented with fractures of the pelvic ring, bilateral femurs, and right tibia/fibula. All fractures were stabilized with external fixation and fixed definitively 48 hours later. Postoperatively, the patient suffered rapid clinical decline. Emergent head computed tomography (CT) demonstrated tonsillar herniation with loss of gray-white matter differentiation. Although respiratory status remained uncompromised throughout presentation, pathology revealed extensive cerebral fat embolism.
Conclusion:
Fat embolism can traverse the lungs without eliciting an inflammatory response, radiographic infiltrate, or impairing gas exchange. This may lead to a clinically silent, fatal cerebral fat embolism in an intubated, sedated patient.
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Flail Chest-I
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
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Assessment:
1. Clinical Evaluation:
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