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Fat emboli syndrome and the orthopaedic trauma surgeon: lessons learned and clinical recommendations

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Abstract

Purpose

Fat emboli syndrome is a rare but well-described complication of long-bone fractures classically characterised by a triad of respiratory failure, mental status changes and petechial rash. In this paper, we present the case of a patient who sustained bilateral femoral fractures and subsequently developed FES. Our aim was to review and summarise the current literature regarding the pathophysiology and management of fat emboli syndrome (FES) and propose an algorithm for treating patients with bilateral femoral fractures to reduce the risk of FES.

Methods

A literature analysis was performed to determine implications in the clinical setting.

Results

Currently, there exists little high-quality evidence to guide the orthopaedic surgeon in identifying patients at highest risk of FES or in preventing FES in patients with multiple long-bone fractures. However, the literature does suggest that the risk is directly related to the volume of marrow displaced and inversely related to both the time to fracture stabilisation and the respiratory reserve of the patient. Based on these correlations, we propose an algorithm for treating patients with bilateral femoral fractures, taking into consideration haemodynamic and pulmonary stability.

Conclusions

Our algorithm for managing bilateral femoral fractures prioritises early stabilisation with external fixation, staged intramedullary nailing and conversion to plate fixation if FES develops. This protocol is meant to be the basis of future investigations of optimal treatment strategies.

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Author information

Authors and Affiliations

  1. Department of Orthopedics, University of Colorado School of Medicine, 12631 E. 17th Avenue, Mail Stop B202, Aurora, CO, 80045, USA

    Robin Hall Dunn & Trevor Jackson

  2. Department of surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA

    Clay Cothren Burlew, Fredric M. Pieracci, Charles Fox, Mitchell Cohen, Eric M. Campion & Ryan Lawless

  3. Department of Orthopaedic Surgery, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204, USA

    Cyril Mauffrey

Authors
  1. Robin Hall Dunn
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  2. Trevor Jackson
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  3. Clay Cothren Burlew
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  4. Fredric M. Pieracci
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  5. Charles Fox
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  6. Mitchell Cohen
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  7. Eric M. Campion
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  8. Ryan Lawless
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  9. Cyril Mauffrey
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Corresponding author

Correspondence to Cyril Mauffrey.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Dunn, R.H., Jackson, T., Burlew, C.C. et al. Fat emboli syndrome and the orthopaedic trauma surgeon: lessons learned and clinical recommendations. International Orthopaedics (SICOT) 41, 1729–1734 (2017). https://doi.org/10.1007/s00264-017-3507-1

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  • DOI: https://doi.org/10.1007/s00264-017-3507-1

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