Prone Positioning for Management of Fat Embolism Syndrome in a Patient with Spine Fracture; An Unusual Scenario and Review of Literature

Tyagi, Asha; Aggarwal, Richa; Soni, Kapil Dev; Trikha, Anjan

doi:10.29252/beat-070217

Cited by 3 publications

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fatal FES related to seemingly harmless isolated osteoporotic vertebral fractures, [3,4] vertebroplasty [5] and posterior spinal fusion [6][7][8][9][10][11] has been reported. The mechanism was hypothesized to be that both vertebral fracture and spinal surgery can involve the bone marrow, which increases the intraosseous pressure; this pressure then dislodges the fat and bone marrow, pushing them out into the venous circulation [1,5] and causing systematic inflammation.…”

Section: Discussionmentioning

confidence: 99%

Fatal fat embolism syndrome during posterior spinal fusion surgery

et al. 2021

View full text Add to dashboard Cite

Rationale: Fat embolism syndrome (FES) is a rare but potentially lethal complication. Although serious FES is associated with long bone fractures and major joint surgery, the number of patients who develop fatal FES intraoperatively is probably higher than the described number. We herein report an extremely rare autopsy-confirmed case of fatal FES during posterior spinal fusion to enhance pedicle screw (PS) fixation with allograft bone augmentation. Patient Concerns: A 74-year-old woman came to the hospital complaining of back pain, lower extremity pain and numbness, and intermittent claudication. Diagnosis: She was diagnosed with lumbar degenerative scoliosis and lumbar spinal canal stenosis based on imaging findings. Interventions: During posterior spinal fusion to enhance pedicle screw fixation with allograft bone augmentation, her blood pressure and oxygen saturation dropped significantly, so the operation was stopped, and cardiopulmonary resuscitation was performed. Chest computed tomography demonstrated bilateral diffuse alveolar infiltrates. Outcomes: The patient died three days later due to fat embolism. The autopsy revealed diffuse myocardial ischemia and diffuse alveolar damage. Numerous fat emboli were observed at lung, kidney and spleen and small necrotic bone fragments, possibly derived from allograft bone debris, were found in the peripheral pulmonary artery. Lessons: Fatal FES associated to seemingly harmless isolated osteoporotic vertebral fractures-vertebroplasty and posterior spinal fusion has been reported. The mechanism was hypothesized to be that both vertebral fractures and spine surgery have the potential to involve bone marrow, thereby increasing intraosseous pressure, and this pressure dislodges fat and bone marrow and pushes them out into the venous circulation, causing systemic inflammation. This is the first report to show histological evidence that the allografted bone embolized to the lungs. Although several reports have indicated that inserting reinforcing materials into the tapped screw holes can enhance the pedicle screw fixation, this procedure may cause severe FES due to fat and debris of material augmentation (i.e. cement, hydroxyapatite, allograft bone). It is important for physicians, especially spinal surgeons, and anesthetists, to be aware of the potential for FES to occur during spinal surgery, which can cause serious complications in a small minority of patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Fatal fat embolism syndrome during posterior spinal fusion surgery

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Some authors recommended using steroids in the early years [ 9 ], but this treatment was rapidly discontinued due to infectious complications. Some authors even recommended prophylactic positioning of these particular patients at risk in the prone position [ 44 ].…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Fat embolism syndrome is clinically diagnosed, with no laboratory and neuroimaging tests that alone provide the diagnosis. In this sense, it is essential to investigate the different differential diagnoses: (a) Traumatic brain injury (TBI), (b) Pulmonary thromboembolism (PTE), and (c) Sepses [5,6]. The anatomopathology of FES has important characteristics such as: petechiae in white matter with enhancement of fat globules in the capillary lumen.…”

Section: Discussionmentioning

confidence: 99%

Fracture of the tibia and fibula in a car accident with cerebral fat embolism syndrome (FES): A case report

Felipe¹,

Rafael²,

José³

et al. 2021

Int J Case Rep Images

View full text Add to dashboard Cite

Introduction: Fat embolism is defined by the presence of fat globules in the pulmonary circulation. The term fat embolism syndrome (FES) refers to the clinical syndrome that follows an identifiable insult that releases fat into the circulation, resulting in pulmonary and systemic symptoms.Case Report: We report a case of a 28-year-old male, victim of a medium impact collision presenting long bone fractures (tibia and fibula) evolving with fat embolism syndrome (FES). Conclusion:Almost all cases of FES are due to fractures of long and pelvic bones (the bone marrow contains a high fat content). However, some cases are associated with trauma in the absence of orthopedic fractures and rare cases are not related to trauma. In this sense, it is

show abstract

Prone Positioning for Management of Fat Embolism Syndrome in a Patient with Spine Fracture; An Unusual Scenario and Review of Literature

Cited by 3 publications

References 12 publications

Fatal fat embolism syndrome during posterior spinal fusion surgery

Fatal fat embolism syndrome during posterior spinal fusion surgery

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

Fracture of the tibia and fibula in a car accident with cerebral fat embolism syndrome (FES): A case report

Contact Info

Product

Resources

About