Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Fat Embolism Syndrome - Three Case Reports and Review of the Literature

  • Received : 2017.06.15
  • Accepted : 2017.09.07
  • Published : 2017.09.30
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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.

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References

  1. Gregorakos L, Dimopoulos G, Mavropanou D, Antypas G. Fat embolism syndrome (FES) in traumatized patients: a five year experience of a single intensive care unit. Appl Cardiopulm Pathophysiol 1996;6:105-9.
  2. Tablot M, Schemitsch EH. Fat embolism syndrome: history, definition, epidemiology. Injury 2006;37(4 Suppl):S3-7.
  3. Abbott MG. Fat embolism syndrome: An in-depth review. Asian J Crit Care 2005;1:19-24.
  4. Gurd AR, Wilson RI. Fat embolism: an aid to diagnosis. J Bone Joint Surg Br 1970;56:732-7.
  5. Gregorakos L, Sakayianni K, Hroni D, Harizopoulou V, Markou N, Georgiadou F, et al. Prolonged coma due to cerebral fat embolism: report of two cases. J Accid Emerg Med 2000;17:144-6. https://doi.org/10.1136/emj.17.2.144
  6. Lehman EP, Moore RM. Fat embolism: including experimental production without trauma. Arch Surg 1927;14:621-62. https://doi.org/10.1001/archsurg.1927.01130150002001
  7. Warthin AS. Traumatic lipaemia and fatty embolism. Int Clinics 1913;23:171-227.
  8. Kara AV, Yildirim Y, Yilmaz S, Yilmaz Z, Kadiroglu AK, Yilmaz AE. Unexpected neurological sequelae following cerebral fat embolism syndrome. J Case Rep 2015;5:207-11. https://doi.org/10.17659/01.2015.0051
  9. Kosova E, Bergmark B, Piazza G. Fat embolism syndrome. Circulation 2015;131:317-20. https://doi.org/10.1161/CIRCULATIONAHA.114.010835
  10. Peltier L. Fat embolism. A perspective. Clin Orthop Relat Res 2004;422:148-53 https://doi.org/10.1097/01.blo.0000131647.64240.89
  11. O'Brien, PJ. Fracture fixation in patients having multiple injuries. Can J Surg 2003;46:124-8.
  12. Robinson CM. Current concepts of respiratory insufficiency syndromes after fracture. J Bone Joint Surg Br 2001;83:781-91.
  13. Sen RK, Prakash S, Tripathy SK, Aqarwal A, Sen IM. Inhalational Ciclesonide found beneficial in prevention of fat embolism syndrome and improvement of hypoxia in isolated skeletal trauma victims. Eur J Trauma Emerg Surg 2017;43:313-8. https://doi.org/10.1007/s00068-016-0633-1
  14. Grigorakos L, Gakis E, Athanasopoulou A, Antonopoulos A. Fat embolism and the intensive care unit. In: Grigorakos L. (Textbook). Intensive care unit. Respiratory insufficiency and mechanical ventilation. before-during-after. Athens: myedition.gr; 2014:529-38.
  15. Alexias G. Reason for life and death. Medical practice as a form of social interaction in intensive care units. Athens: Ellinika Grammata; 2000.

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