Fat embolism syndrome. A 10-year review

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Orthopedic Surgery

Background:

• The impact of modern critical care and early fracture fixation on fat embolism syndrome (FES) is not well-defined.
• FES diagnosis and management require updated understanding in current clinical practice.

Purpose of the Study:

• To define FES in contemporary practice through a decade-long review at a level I trauma center.
• To analyze patient demographics, injury characteristics, diagnostic methods, and treatment strategies for FES.

Main Methods:

• Retrospective review of medical records for FES patients from July 1, 1985, to July 1, 1995.
• Data collected included demographics, injury severity scores, fracture patterns, diagnostic clinical criteria, and management interventions.
• Analysis of FES incidence, clinical presentation, and outcomes in relation to fracture types and fixation timing.

Main Results:

• Twenty-seven patients were diagnosed with clinically apparent FES, yielding an incidence of 0.9% among long-bone fracture patients.
• Common clinical criteria included hypoxia (96%), tachycardia (93%), and temperature elevation (70%).
• Early operative fixation (within 24 hours) was performed in 74% of FES patients, comparable to the general fracture population, with a 7% mortality rate.

Conclusions:

• Fat embolism syndrome is a clinical diagnosis of exclusion, often presenting atypically in severely injured patients.
• No correlation was found between FES and specific fracture patterns or locations.
• Early intramedullary fixation does not appear to increase FES incidence or severity; supportive care remains the mainstay of management.