Early acute fat embolism syndrome caused by femoral fracture: A case report

Abstract

BACKGROUND Fat embolism syndrome (FES) is a rare complication caused by the presence of fat particles in the microcirculation, which usually occurs within 12-72 h after trauma. At present, there have been few cases of fat embolism presenting within 3 h after trauma. Here, we report a case of femoral fracture complicated with an acute fat embolism caused by a car accident. CASE SUMMARY A 29-year-old woman with pain, swelling and limited movement of her left lower limb after a car accident was taken by ambulance to our hospital. X-ray examination showed fracture of the middle and lower part of the left femur and fracture of the base of the left fifth metatarsal bone. She was hospitalized and admitted to the orthopedic ward. After the attending doctor performed tibial tubercle bone traction, the patient became confused, followed by respiratory distress. Finally, she was transferred to the intensive care unit. After nearly a month of treatment in the intensive care unit, the patient's cognitive function gradually recovered over 6 mo. CONCLUSION For patients with early traumatic fractures, young emergency physicians and orthopedics should be aware of the possibility of FES.

A Case of Fulminant Fat Embolism Syndrome With Very Early Onset After Femoral Neck and Sacral Fractures

“…Among the reported fulminant FES cases, seven cases [13][14][15][16][17][18], including our case, were identified that developed less than 3 h after injury, with our case being the earliest after injury (Table 2). Most of the fulminant FES cases were severely ill. Another possible mechanism for cerebral fat embolization is that pulmonary fat embolization increases right atrial pressure, causing the leftover patent foramen ovale (PFO) to open, resulting in a right-to-left shunt, which allows fat droplets to flow into the arterial side and cause cerebral infarction [19].…”