Fat Embolism Syndrome: A Case Series from a Single Tertiary Care Hospital

Fat embolism syndrome (FES) is a rare but potentially fatal complication predominantly affecting young adults following long bone fractures. No definitive diagnostic test exists; diagnosis remains one of exclusion based on Gurd's criteria. Early recognition before the syndrome becomes fully established is critical to reduce preventable mortality.

We report a case series of six patients diagnosed with FES between 2020 and 2025, examining their clinical and laboratory parameters, including injury severity score, number of fractures, interleukin-6 (IL-6), C-reactive protein (CRP), hemoglobin (Hb), platelet count, and neurological status in relation to FES development. We charted the key parameters to depict the natural history of FES.

All six patients were young adults (age 21-32 years) who sustained long bone fractures following road traffic accidents. All developed hypoxia and neurological deterioration (Glasgow coma scale drop) within days. Serum IL-6 and CRP were elevated in all patients for whom these were measured. All patients showed a fall in Hb and thrombocytopenia. Petechiae were present in 4/6 cases (67%). Two patients died (33%); both had high injury burden and markedly elevated IL-6.

Hypoxia and elevated IL-6 appear to be the earliest detectable indicators of evolving FES, preceding the full clinical syndrome. Acute anemia, thrombocytopenia, hypoalbuminemia, and oliguria were common. Only after the disease is clinically advanced Gurd's criteria were fulfilled. Rapid fracture stabilisation, continuous SpO2 monitoring, serial IL-6 measurement, and universal team awareness are essential strategies for its potential prevention.