Suspected Fat Embolism Syndrome in the Setting of Ballistic Long Bone Fractures: A Case Report

Fat embolism syndrome (FES) is a rare, life-threatening condition most seen in traumatic orthopedic injuries, especially long bone fractures. Classically, FES presents with hypoxemia, neurological abnormalities, or a petechial rash; however, clinical findings can extend beyond this classic triad. Since FES is a clinical diagnosis, emergency physicians must recognize both classic and subtle presentations.

A 22-year-old female presented as a transfer from an outside hospital for multiple long bone fractures secondary to gunshot wounds. Upon arrival, she was found to be hypoxic, despite no signs of thoracic injury on exam or initial imaging. Her presentation, laboratory findings, and repeat imaging were consistent with FES. She was given supportive care through supplemental oxygen and close monitoring. She improved with supportive care and was discharged home in stable condition.

Although there is no definitive treatment for fat embolism syndrome, prompt recognition of the various clinical findings associated with FES by emergency physicians can expedite supportive care, allow prompt admission to a critical care unit, and aid with monitoring for potential deterioration.