Fat embolism syndrome: a case series and review of literature

Abstract

Fat embolism and fat embolism syndrome (FES) is a clinical spectrum characterized by dissemination of fat emboli into the systematic circulation usually as a result of orthopedic trauma and related surgical procedures. we present a case series of three patients who had FES of variable presentation and severity. In our first case patient initially developed FES pre operatively which was complicated by acute pulmonary thromboembolism in the post operative period. In our third case patient developed FES after intra medullary nail fixation of femoral shaft fracture. Fat embolism is relatively rare but fatal complication in orthopedic trauma and during long bone fracture manipulations. In addition, fat embolism is a risk factor for pulmonary thromboembolism as was evident in our first case. So, patients of fat embolism should be closely monitored for the later. Gurd and Wilson are the most commonly used criteria for the diagnosis of FES. Treatment is largely supportive and some preventive measures include early fixation of long bone fractures. Prophylactic use of steroids in a meta-analysis has been found to prevent occurrence of FES in nearly two third of patients. There is no proven role of hypertonic dextrose infusion, heparin or corticosteroids in the treatment of FES and therefore are not routinely recommended. In case of fulminant FES steroids should be considered.