Fat Embolism Syndrome – Three Case Reports and Review of the Literature

Abstract

The fat embolism syndrome (FES) represents a condition, usually with traumatic etiology, which may pose challenges to diagnosis while its treatment usually requires supportive measures in the intensive care units (ICUs). The clinical criteria, including respiratory and cerebral dysfunction and a petechial rash, along with imaging studies help in diagnosis. Here we present three case reports of young male who developed FES and were admitted to our ICUs after long bones fractures emerging after vehicle crashes and we briefly review FES literature. All patients' treatment was directed towards: 1) the restoration of circulating volume with fresh blood and/or plasma; 2) the correction of acidosis; and 3) immobilization of the affected part. All patients recovered and were released to the orthopedic wards. The incidence of cases of patients with FES admitted in our ICUs records a significant decrease. This may be explained in terms effective infrastructure reforms in Greece which brought about significant improvement in early prevention and management.

Late-onset isolated cerebral fat embolism syndrome after a simple tibial plateau fracture: a rare case report

“… 18 , 19 The fat embolism index score proposed by Schonfeld is also helpful and is based on seven clinical signs; a positive diagnosis of FES is suggested if a cumulative score of ≥5 is achieved during the first 3 days of hospitalization. 4 , 20 …”

“…18,19 The fat embolism index score proposed by Schonfeld is also helpful and is based on seven clinical signs; a positive diagnosis of FES is suggested if a cumulative score of !5 is achieved during the first 3 days of hospitalization. 4,20 Patients with isolated cerebral fat embolism have no respiratory dysfunction but exhibit a change of consciousness, which is usually accompanied by new-onset neurological deficit, apathy, convulsion, hallucination, facial palsy, or hemiplegia. Although the patient in the current case did not initially meet Gurd and Wilson's criteria 17 (only one major and three minor criteria were met: cerebral symptoms in a patient with non-head injury, tachycardia, renal changes, and drop in hemoglobin), cerebral fat embolism was strongly considered because the patient presented with sudden unresponsiveness, dullness, and muteness with quadriplegia 10 days after fixation of the left tibial plateau fracture.…”

“…However, incidence rates of FES ranging from <1% to 29% have been reported. 4 , 5 The two main theories for the formation of fat embolism are the mechanical theory, which emphasizes vascular obstruction, and the biochemical theory, which emphasizes the inflammatory response that results from the trauma and leads to the development of embolized fat tissue. 6 Multiorgan dysfunction may occur, causing FES and presenting as a clinical triad of hypoxia, change of consciousness, and petechiae.…”

“… 7 A change in consciousness occurs in up to 86% of patients with manifestations ranging from headache to coma. 4 , 5 , 8 Two cases of early-onset FES have been reported at 3 hours and <12 hours post-injury, respectively. 9 – 11 Although the neurological deficit is thought to be transient and reversible in most cases, the condition may be complicated by misdiagnosis or delayed diagnosis.…”

Síndrome de dificultad respiratoria aguda (SDRA) secundario a embolia grasa, un desafío diagnóstico, reporte de caso y revisión de la literatura.

“…(12) En las tablas se describen los criterios diagnósticos para cada autor y los encontrados en nuestro paciente. Actualmente no existe un tratamiento específico para el SEG, la actuación médica debe enfocarse a su prevención, que se basa en la corrección rápida del shock inicial, la estabilización y fijación de las fracturas de huesos largos en el trauma múltiple dentro de las primeras 24 horas (9)(11),realizando esta intervención Grigorakos et al menciona una reducción del 70% en las complicaciones pulmonares (14). Además la literatura recomienda priorizar la fijación externa sobre la intramedular en los casos que se pueda (15).…”