Fat Embolism and Fat Embolism Syndrome

Abstract

Fat embolism (FE) occurs frequently after trauma and during orthopaedic procedures involving manipulation of intramedullary contents. Classically characterized as a triad of pulmonary distress, neurologic symptoms, and petechial rash, the clinical entity of FE syndrome is much less common. Both mechanical and biochemical pathophysiologic theories have been proposed with contributions of vascular obstruction and the inflammatory response to embolized fat and trauma. Recent studies have described the relationship of embolized marrow fat with deep venous thrombosis and postsurgical cognitive decline, but without clear treatment strategies. Because treatment is primarily supportive, our focus must be on prevention. In trauma, early fracture stabilization decreases the rate of FE syndrome; however, questions remain regarding the effect of reaming and management of bilateral femur fractures. In arthroplasty, computer navigation and alternative cementation techniques decrease fat embolization, although the clinical implications of these techniques are currently unclear, illustrating the need for ongoing education and research with an aim toward prevention.

Perioperative support of a patient with fat embolism syndrome with extracorporeal membraneoxygenation

“…There is sufficient evidence that early definitive long bone fracture fixation is important in the prevention of respiratory complications such as fat embolism, ARDS and pneumonia 10 11. Specifically, early definitive therapy is the most important factor in preventing further fat embolisation in established FES 1. However, the approach of ‘damage control orthopaedics’ including traction and external fixation is often advocated for the unstable patient 11 12.…”

“…Fracture fixation carried the risk of further lung injury from embolisation of fat, so it was important to sustain this insult early in his course of ECMO, maximising time to recovery postoperatively. Early fracture fixation is the single most important factor in preventing further fat embolisation1 and leaving the fractures unfixed also allows ongoing release of inflammatory mediators which can further worsen ARDS and multiorgan failure 17. Additionally, getting the patient out of traction facilitates basic nursing cares which are required with patients on ECMO.…”

“…Fat embolism syndrome (FES) is a serious complication of trauma. Early fixation is important in reducing embolic load and ongoing complications 1. However, patients can develop marked respiratory and haemodynamic compromise which complicates the feasibility of early definitive operative management.…”

Paroxysmal sympathetic hyperactivity syndrome caused by fat embolism syndrome

“…( 7 - 9 ) The diagnostic criteria are presented in table 1 . Neurological signs and symptoms are present in 80 - 85% of cases, ( 6 - 8 ) but the incidence of cerebral fat embolism (i.e., a fat embolism presenting with predominant neurological manifestations) is unknown. ( 10 - 13 ) The main neurological feature of FES is an alteration of consciousness that can range from confusion to coma, and few more than 20% of cases may present with focal deficits, abnormal motor responses or seizures.…”

COVID-19 and fat embolism: a hypothesis to explain the severe clinical outcome in people with obesity

“…FES is a miscellanea of respiratory, hematological, neurological, and cutaneous symptoms and signs-related to trauma or multiple surgical and medical complications-and due to fat embolism in the microcirculation [16]. Of note, obesity per se was never described as a cause of FES [17][18][19]. Clinical diagnosis of FES is difficult, especially when unsuspected in the absence of severe trauma or bone fractures.…”