Fat embolism syndrome: etiology, pathogenesis and treatment

A special type of respiratory distress syndrome has been described in connection with fractures of the long bones, called fat embolism syndrome. In addition to the respiratory signs - tachypnoea, hypoxaemia and snow storm infiltrations in the chest x-ray films- the syndrome consists of petechiae, thrombocytopenia, cerebral disturbances, pyrexia etc. The respiratory insufficiency in this syndrome may be explained by a coagulation disorder, in which the release of tissue thromboplastins from the traumatized tissues results in an interstitial pneumonitis and peripheral thrombocytopenia. Accumulation of fat in the lung microvasculature has been observed both clinically and post morten. The importance of fat for the pathogenesis of the syndrome is not clear, but fat globuli are present in quantities, which are not encountered in other types of post-traumatic pulmonary insufficiency. Careful observation of a patient with multiple fractures is the cornerstone of early diagnosis. Cautions handling and early stabilization of fractures reduce the tissue trauma and may thus reduce the manifestations of the fat embolism syndrome. Respiratory assistance is given when necessary, and most often the syndrome is self-resolving. Fulminant cases with increasing symptomatology are treated with methylprednisolone and respirator.