Skip to main content
SpringerLink
Log in

Epidemiology and risk factors for fat embolism in isolated lower extremity long bone fractures

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Fat embolism syndrome (FES) is a serious complication after orthopedic trauma. The aim of this study was to identify risk factors for FES in isolated lower extremity long bone fractures.

Methods

The National Trauma Data Bank “NTDB” study included patients with isolated femoral and tibial fractures. A total of 344 patients with FES were propensity score matched with 981 patients without FES. Multivariate logistical regression was used to identify independent risk factors for FES.

Results

FES was diagnosed in 344 (0.03%) out of the 1,251,143 patients in the study populations. In the two matched groups, the mortality was 7% in the FES group and 1% in the No FES group (p < 0.001). FES was associated with an increased risk of ARDS, VTE, pneumonia, AKI, and stroke. Younger age, femur fractures, obesity, and diabetes mellitus were independent predictors of FES. Early operative fixation (≤ 48 h) was protective against FES.

Conclusion

FES increases mortality by seven times. Young age, obesity, and diabetes mellitus are significant independent risk factors for FES. Early fixation is independently associated with a reduced risk of FES.

Level of evidence

Level III.

Study type

Prognostic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Zenker FA. Braunsdorf: Dresden; BeitragezurAnatomie und Physiologieder Lunge. 1861.p.20.

  2. Gurd AR. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br. 1970;52:732–7.

    Article  CAS  PubMed  Google Scholar 

  3. Stein PD, Yaekoub AY, Matta F, Kleerekoper M. Fat embolism syndrome. Am J Med Sci. 2008;336:472–7.

    Article  PubMed  Google Scholar 

  4. Akhtar S. Fat embolism. Anesthesiol Clin. 2009;27(3):533–50 (table of contents).

    Article  PubMed  Google Scholar 

  5. Godoy DA, Di Napoli M, Rabinstein AA. Cerebral fat embolism: recognition, complications, and prognosis. Neurocrit Care. 2018;29(3):358–65.

    Article  PubMed  Google Scholar 

  6. Bodanapally UK, Shanmuganathan K, Saksobhavivat N, Sliker CW, Miller LA, Choi AY, et al. MR imaging and differentiation of cerebral fat embolism syndrome from diffuse axonal injury: application of diffusion tensor imaging. Neuroradiology. 2013;55(6):771–8.

    Article  PubMed  Google Scholar 

  7. Bulger EM, Smith DG, Maier RV, et al. Fat embolism syndrome. A 10-year review. Arch Surg. 1997;132(435):439.

    Google Scholar 

  8. Fabian TC, Hoots AV, Stanford DS, et al. Fat embolism syndrome: prospective evaluation in 92 fracture patients. Crit Care Med. 1990;18(42):46.

    Google Scholar 

  9. Alpert M, Grigorian A, Scolaro J, Learned J, Dolich M, Kuza CM, Lekawa M, Nahmias J. Fat embolism syndrome in blunt trauma patients with extremity fractures. J Orthop. 2020;6(21):475–80.

    Article  Google Scholar 

  10. Sakamoto T, Sawada Y, Yukioka T, et al. Computed tomography for diagnosis and assessment of cerebral fat embolism. Neuroradiology. 1983;24:283–5.

    Article  CAS  PubMed  Google Scholar 

  11. Chrysikopoulos H, Maniatis V, Pappas J, et al. Case report: posttraumatic cerebral fat embolism: CT and MR findings report of two cases and review of the literature. Clin Radiol. 1996;51:728–32.

    Article  CAS  PubMed  Google Scholar 

  12. Mittal MK, Burrus TM, Campeau NG, Eckel LJ, Rabinstein AA, Wijdicks EF. Pearls & oy-sters: good recovery following cerebral fat embolization with paroxysmal hyperactivity syndrome. Neurology. 2013;81:e107–9.

    Article  PubMed  Google Scholar 

  13. Lempert M, Halvachizadeh S, Ellanti P, Pfeifer R, Hax J, Jensen KO, Pape HC. Incidence of fat embolism syndrome in femur fractures and its associated risk factors over time-a systematic review. J Clin Med. 2021;10(12):2733.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Kainoh T, Iriyama H, Komori A, Saitoh D, Naito T, Abe T. Risk factors of fat embolism syndrome after trauma: a nested case-control study with the use of a nationwide trauma registry in Japan. Chest. 2021;159(3):1064–71.

    Article  PubMed  Google Scholar 

  15. De Lima E, Souza R, Apgaua BT, Milhomens JD, et al. Severe fat embolism in perioperative abdominal liposuction and fat grafting. Braz J Anesthesiol. 2016;66:324.

    Google Scholar 

  16. Eriksson EA, Pellegrini DC, Vanderkolk WE, Minshall CT, Fakhry SM, Cohle SD. Incidence of pulmonary fat embolism at autopsy: an undiagnosed epidemic. J Trauma. 2011;71(2):312–5. https://doi.org/10.1097/TA.0b013e3182208280.

    Article  PubMed  Google Scholar 

  17. Tsai IT, Hsu CJ, Chen YH, Fong YC, Hsu HC, Tsai CH. Fat embolism syndrome in long bone fracture: clinical experience in a tertiary referral center in Taiwan. J Chin Med Assoc. 2010;73(8):407–10.

    Article  PubMed  Google Scholar 

  18. Prashanth N, Neeta PN, Shilpa K. Fat embolism syndrome in single long bone fracture of lower limb: a clinical experience. Int J Pharma Med Biol Sci. 2014;3(4):40–8.

    Google Scholar 

  19. Yu EW, Greenblatt L, Eajazi A, Torriani M, Bredella MA. Marrow adipose tissue composition in adults with morbid obesity. Bone. 2017;97:38–42.

    Article  CAS  PubMed  Google Scholar 

  20. Aggarwal R, Banerjee A, Soni KD, Kumar A, Trikha A. Clinical characteristics and management of patients with fat embolism syndrome in level I Apex Trauma Centre. Chin J Traumatol. 2019;22(3):172–6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Giannoudis PV, Tzioupis C, Pape HC. Fat embolism: the reaming controversy. Injury. 2006;37(Suppl 4):S50–8. https://doi.org/10.1016/j.injury.2006.08.040.

    Article  PubMed  Google Scholar 

  22. Li AB, Zhang WJ, Guo WJ, Wang XH, Jin HM, Zhao YM. Reamed versus unreamed intramedullary nailing for the treatment of femoral fractures: a meta-analysis of prospective randomized controlled trials. Medicine (Baltimore). 2016;95(29):e4248.

    Article  PubMed  Google Scholar 

  23. Bone LB, Johnson KD, Weigelt J, Scheinberg R. Early ver sus delayed stabilization of femoral fractures: a prospective randomized study. Clin Orthop Relat Res. 1989;71(3):336–40.

    CAS  Google Scholar 

  24. Gossling HR, Donohue TA. The fat embolism syndrome. JAMA. 1979;241(25):2740–2.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Khemajira Karaketklang for statistical consult.

Author information

Authors and Affiliations

  1. Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, University of Southern California, Los Angeles, CA, USA

    Natthida Owattanapanich, Meghan Lewis, Subarna Biswas & Demetrios Demetriades

  2. Department of Surgery, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA

    Elizabeth R Benjamin

  3. Division of Trauma Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Natthida Owattanapanich

Authors
  1. Natthida Owattanapanich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meghan Lewis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Subarna Biswas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elizabeth R Benjamin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Demetrios Demetriades
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NO Collection of data, analysis ML Analysis of data, manuscript preparation SB statistical analysis, critical review of manuscript EB concept of study, analysis, critical review of manuscript DD concept of study, supervision of data collection, analysis, manuscript

Corresponding author

Correspondence to Demetrios Demetriades.

Ethics declarations

Ethical approval

All procedures performed in this retrospective observational study involving human participants were in accordance with the ethical standards of the Institutional Review Board of the University of California (HS-21–00223) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study received a waiver for informed consent by the Institutional Review Board of the University of Southern California (HS-21–00223).

Competing interests

The authors declare no competing interests.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 26 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Owattanapanich, N., Lewis, M., Biswas, S. et al. Epidemiology and risk factors for fat embolism in isolated lower extremity long bone fractures. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02516-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00068-024-02516-9

Keywords

Search

Navigation