Bilateral femoral shaft fractures complicated by fat and pulmonary embolism: a case report

Randelli, Filippo; Capitani, Paolo; Pace, Fabrizio; Favilla, Sara; Galante, Claudio; Randelli, Pietro

doi:10.1016/s0020-1383(15)30041-3

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…The strong reduction in the frequency of FES after 30 years of age may signify that the energy of the impacts causing bone fractures decreases as the age of the subject increases. This supports previous reports suggesting that FES is more frequently associated with complicated trauma [27][28][29][30].…”

Section: Discussionsupporting

confidence: 92%

Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports

Vetrugno

Bignami

Deana

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background The incidence of cerebral fat embolism (CFE) ranges from 0.9–11%, with a mean mortality rate of around 10%. Although no univocal explanation has been identified for the resulting fat embolism syndrome (FES), two hypotheses are widely thought: the ‘mechanical theory’, and the ‘chemical theory’. The present article provides a systematic review of published case reports of FES following a bone fracture. Methods We searched MEDLINE, Web of Science and Scopus to find any article related to FES. Inclusion criteria were: trauma patients; age ≥ 18 years; and the clinical diagnosis of CFE or FES. Studies were excluded if the bone fracture site was not specified. Results One hundred and seventy studies were included (268 cases). The male gender was most prominent (81.6% vs. 18.4%). The average age was 33 years (±18). The mean age for males (29 ± 14) was significantly lower than for females (51 ± 26) (p < 0.001). The femur was the most common fracture site (71% of cases). PFO was found in 12% of all cases. Univariate and multivariate regression analyses showed the male gender to be a risk factor for FES: RR 1.87 and 1.41, respectively (95%CI 1.27–2.48, p < 0.001; 95%CI 0.48–2.34, p < 0.001). Conclusions FES is most frequent in young men in the third decades of life following multiple leg fractures. FES may be more frequent after a burst fracture. The presence of PFO may be responsible for the acute presentation of cerebral embolisms, whereas FES is mostly delayed by 48–72 h.

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Section: Discussionsupporting

confidence: 92%

Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports

Vetrugno

Bignami

Deana

et al. 2021

Scand J Trauma Resusc Emerg Med

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“…The incidence of adult respiratory distress syndrome is also considered significantly higher in bilateral fractures [ 13 ]. Additionally, fat embolism syndrome (FES) in bilateral femur fractures has been reported to be higher than in unilateral ones (1–10%) [ 14 ]. However, Bonnevialle et al.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous bilateral extracapsular proximal femur fractures in the elderly. A case report

Rodríguez-Zamorano

Galán-Olleros

García-Coiradas

et al. 2022

Journal of Surgical Case Reports

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Simultaneous and bilateral proximal femoral fractures (PFF) are rare and have scarcely been reported in the literature. A case of a bilateral extracapsular PFF is herein presented. Besides, an exhaustive review of the literature was performed, analyzing the information of all previously reported cases. An 81-year-old woman, who suffered a casual fall, was diagnosed with bilateral PFF consisting of both a subtrochanteric and an intertrochanteric fracture. She underwent concurrent intramedullary fixation for both fractures without any relevant complication and started early ambulation. Simultaneous bilateral extracapsular PFF are exceptional, with only 23 cases described in the current literature. In the elderly, they deserve special attention with treatment strategies in between the ones for unilateral hip fractures and those provided to old multiply injured patients. PFF management is not well established. Minimal reaming and careful nailing can be safely performed bilaterally under close monitoring, in order to start an early functional recovery.

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“…Although Pinney described a slight trend of delays in surgery associated with higher incidences of FES, especially in younger men [ 35 ], their findings had no statistical significance. Of note, some studies also reported the onset of FES prior to surgery, even within 24 h after the initial trauma [ 19 , 82 , 83 ]. We hypothesize that the inclusion of endpoints of resuscitation [ 84 ], application of lactate clearance [ 85 ], and revised criteria for patients at special risk (borderline patients) have played a role [ 86 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time—A Systematic Review

Lempert¹,

Halvachizadeh²,

Ellanti

et al. 2021

JCM

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Background: Fat embolism (FE) continues to be mentioned as a substantial complication following acute femur fractures. The aim of this systematic review was to test the hypotheses that the incidence of fat embolism syndrome (FES) has decreased since its description and that specific injury patterns predispose to its development. Materials and Methods: Data Sources: MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched for articles from 1 January 1960 to 31 December 2019. Study Selection: Original articles that provide information on the rate of FES, associated femoral injury patterns, and therapeutic and diagnostic recommendations were included. Data Extraction: Two authors independently extracted data using a predesigned form. Statistics: Three different periods were separated based on the diagnostic and treatment changes: Group 1: 1 January 1960–12 December 1979, Group 2: 1 January 1980–1 December 1999, and Group 3: 1 January 2000–31 December 2019, chi-square test, χ2 test for group comparisons of categorical variables, p-value < 0.05. Results: Fifteen articles were included (n = 3095 patients). The incidence of FES decreased over time (Group 1: 7.9%, Group 2: 4.8%, and Group 3: 1.7% (p < 0.001)). FES rate according to injury pattern: unilateral high-energy fractures (2.9%) had a significantly lower FES rate than pathological fractures (3.3%) and bilateral high-energy fractures (4.6%) (p < 0.001). Conclusions: There has been a significant decrease in the incidence of FES over time. The injury pattern impacts the frequency of FES. The diagnostic and therapeutic approach to FES remains highly heterogenic to this day.

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Bilateral femoral shaft fractures complicated by fat and pulmonary embolism: a case report

Cited by 12 publications

References 26 publications

Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports

Cerebral fat embolism after traumatic bone fractures: a structured literature review and analysis of published case reports

Simultaneous bilateral extracapsular proximal femur fractures in the elderly. A case report

Incidence of Fat Embolism Syndrome in Femur Fractures and Its Associated Risk Factors over Time—A Systematic Review

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