Fat embolism syndrome in femoral shaft fractures: does the initial treatment make a difference?

Silva, Jânio José Alves Bezerra; Diana, Diogo de Almeida; Salas, Victor Eduardo Roman; Zamboni, Caio; Neto, José Soares Hungria; Christian, Ralph Walter

doi:10.1016/j.rboe.2016.08.021

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…There have been previously conflicting results regarding the association of FES with fracture surgery. 32,33,36 The majority of femoral shaft fractures are treated operatively with a medullary nail. In a prospective, consecutive, nonrandomized clinical trial, Kropfl et al looked at 36 adult patients with femur fractures treated surgically with femoral nailing, separated into reamed and unreamed cohorts.…”

Section: Discussionmentioning

confidence: 99%

Fat embolism syndrome in blunt trauma patients with extremity fractures

Alpert

Grigorian²,

Scolaro³

et al. 2020

Journal of Orthopaedics

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Section: Discussionmentioning

confidence: 99%

Fat embolism syndrome in blunt trauma patients with extremity fractures

Alpert

Grigorian²,

Scolaro³

et al. 2020

Journal of Orthopaedics

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“…Although studies on these issues are rare, in patients admitted to emergency units due to trauma with rib fractures who require inpatient management in thoracic surgery clinics, FES symptoms are either not observed or very rare. Silva et al reported that of 229 cases with rib fractures, FES developed in only five (2.2%) 31. In the thoracic surgery clinic of our hospital, FES was not detected in any of the 709 patients with rib fractures monitored and treated due to trauma in 1998–2017.…”

Section: Discussionmentioning

confidence: 64%

<p>Histopathological evaluation of autopsy cases with isolated pulmonary fat embolism (IPFE): is cardiopulmonary resuscitation a main cause of death in IPFE?</p>

E¹,

Çelik²,

Pehlivan³

et al. 2019

OAEM

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Background: Fat embolism (FE) may develop following many traumatic and atraumatic clinical conditions; however, fewer data exist regarding the occurrence of isolated pulmonary FE (IPFE). Cardiopulmonary resuscitation (CPR) is an emergency procedure for maintaining blood circulation and oxygenation during cardiac arrest. In this study, we aimed to evaluate the association of CPR with IPFE in autopsy cases. Methods: A total 402 cases among 4,118 autopsies were diagnosed with IPFE, and the medical background of these cases was retrospectively evaluated. Diagnosis of FE and FE grading were performed with histopathological examinations of postmortem tissue samples, and injury-severity scores of traumatic cases were assessed. Data of traumatic and atraumatic cases were statistically compared. Results: Of the IPFE cases, 298 (741%) were male and 104 (25.9%) female, with overall mean age 53.7 (2–99) years. Causes of death of studied subjects were traumatic for 302 (75.1%) and atraumatic reasons for 100 (24.9%) cases. CPR was performed for 277 cases of which 177 (63.9%) were traumatic and 100 (36.1%) were non-traumatic. In comparison to traumatic cases, significantly higher CPR frequency was determined in atraumatic IPFE ( P =0.001). High grade FE in the traumatic cases, and mild-moderate grade of FE in the nontraumatic cases were found statistically significant ( P =0.001). Conclusion: This study indicates that CPR may be one of the leading factors in the development of IPFE in atraumatic conditions, and this procedure was related to mild–moderate IPFE manifestations. Regardless of whether conditions were traumatic or atraumatic, in patients who survive following CPR for manifest ventilation/perfusion problems, it should be remembered that IPFE may have developed due to CPR.

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“…Polytraumatized individuals were more likely to develop FES (5 of 6 patients). 17 There were no patients diagnosed with FES in the current investigation; however, 1 patient suffered intraoperative cardiac arrest, and FES remained in the differential as a potential etiology.…”

Section: Discussionmentioning

confidence: 65%

“…Although not reported in the investigations on skeletal traction referenced above, fat embolism syndrome (FES) is a rare event (,1-3%) associated with femur fractures. 9,12 Bezerra Silva et al 17 retrospectively studied 272 patients with femoral shaft fractures and reported 6 cases of FES. The initial treatment, which included rest, skeletal traction, external fixation, or immediate stabilization, was not associated with FES.…”

Section: Discussionmentioning

confidence: 99%

Skeletal Traction for Isolated Femur Fractures Does not Reduce Opioid Consumption

Mullis,

Caballero,

Seetharam

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: Isolated femoral shaft fractures can be treated preoperatively with skeletal traction (TXN) or maintenance of a position of comfort (COMF). The goal of this retrospective review was to determine if preoperative opioid consumption differs significantly between these forms of treatment. METHODS: Design: Case-control retrospective study Setting: Two academic level 1 trauma centers Patient Selection Criteria: Patients presenting to the emergency department with isolated OTA/AO 32A-C femoral shaft fractures from 2017-2020. Outcome Measures and Comparisons: The primary outcome was preoperative opioid consumption (morphine milligram equivalents (MME)) comparing patients treated with application of skeletal traction (TXN) or placed in a position of comfort (COMF). RESULTS: Two hundred and twenty patients were studied (COMF n=167, TXN n=53). Multivariate regression analysis revealed significantly greater preoperative opioid consumption in the Emergency Department (ED) for the TXN group compared to COMF (2.6 more MME [CI 0.23,4.96], p=0.031)). There was no difference in preoperative opioid consumption between groups on the hospital floor (p=0.811) nor during the entire preoperative course (p=0.486). The total preoperative rate of opioid consumption (MME/hour) did not differ (p=0.825). CONCLUSIONS: Patients with isolated femoral shaft fractures treated preoperatively with skeletal traction consumed more opioids in the ED compared to patients treated in a position of comfort but no difference in opioid consumption was observed between groups for the entire preoperative course. A position of comfort may be considered as an acceptable alternative to skeletal traction for patients with isolated femur fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Fat embolism syndrome in femoral shaft fractures: does the initial treatment make a difference?

Cited by 5 publications

References 9 publications

Fat embolism syndrome in blunt trauma patients with extremity fractures

Fat embolism syndrome in blunt trauma patients with extremity fractures

<p>Histopathological evaluation of autopsy cases with isolated pulmonary fat embolism (IPFE): is cardiopulmonary resuscitation a main cause of death in IPFE?</p>

Skeletal Traction for Isolated Femur Fractures Does not Reduce Opioid Consumption

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