International Orthopaedics

, Volume 41, Issue 9, pp 1729–1734 | Cite as

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

  • Robin Hall Dunn
  • Trevor Jackson
  • Clay Cothren Burlew
  • Fredric M. Pieracci
  • Charles Fox
  • Mitchell Cohen
  • Eric M. Campion
  • Ryan Lawless
  • Cyril MauffreyEmail author
Original Paper



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.


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


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.


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.


Fat emboli syndrome Bilateral femur fractures Damage control orthopaedics Complication Femur shaft fracture 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


There is no funding source.

Ethical approval

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


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Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  1. 1.Department of OrthopedicsUniversity of Colorado School of MedicineAuroraUSA
  2. 2.Department of surgeryDenver Health Medical CenterDenverUSA
  3. 3.Department of Orthopaedic SurgeryDenver Health Medical CenterDenverUSA

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