Fat embolism syndrome in blunt trauma patients with extremity fractures

Alpert, Miriam; Grigorian, Areg; Scolaro, John A.; Learned, James; Dolich, Matthew; Kuza, Catherine M.; Lekawa, Michael; Nahmias, Jeffry

doi:10.1016/j.jor.2020.08.040

Cited by 5 publications

(5 citation statements)

References 38 publications

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“…Early series reported an incidence of FES of about 20% while more recent studies reported an incidence ranging from 1.4% to 12.8%, depending on the diagnostic criteria used . Other large studies from major trauma centers reported an incidence of ranging from 0.9% to 12.8% (5,6) In the present study, which focused on isolated lower extremity long fractures, the incidence was 0.03%, which is similar to the one reported in another recent study in 2020 (7) The diagnosis of FES is based on a combination of clinical and neuroimaging ndings and can be di cult in the multi trauma patient with associated brain and chest trauma. In cases of cerebral FES the CT scan is usually nonspeci c and often shows brain edema or small hypotense areas of microhemorrhages (8).…”

Section: Discussionsupporting

confidence: 86%

“…In a previous study, Alpert et al reported the average age of patients with fat embolism was 29 years as compared to 59 in patient without FES. The authors suggested that a possible explanation is the more severe mechanisms of injury and therefore more severe fractures in younger patients (7) However, in our study, this aspect was addressed with matching for mechanism of injury and in the multivariate analysis and younger age persisted as a risk factor.…”

Section: Discussionmentioning

confidence: 78%

“…A possible explanation is the higher fat concentration in the femoral metaphysis in diabetic patients (18) Another controversial and much debated issue is whether open or closed fracture has a higher risk for fat embolism. Some studies have reported that closed fractures are associated with a higher risk of FES (2,7) . On the other hand, Kainoh et al performed a conditional logistic regression model for risk factors of fat embolism and found approximately 3-4 times higher incidence of fat embolism in open long bone fractures, both in upper and lower extremities.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology and Risk Factors for Fat Embolism in Isolated Lower Extremities Long Bone Fractures

Owattanapanich,

Lewis,

Biswas

et al. 2024

Preprint

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BACKGROUND: 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: NTDB study, included patients with isolated femoral and tibial fractures. 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 were independent predictors of FE. Early operative fixation (≤ 48 h) was protective against FES. CONCLUSIONS: FES increases mortality by seven times. Young age, obesity, and diabetes are significant independent risk factors for FES. Early fixation is independently associated with a reduced risk of FES.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Epidemiology and Risk Factors for Fat Embolism in Isolated Lower Extremities Long Bone Fractures

Owattanapanich,

Lewis,

Biswas

et al. 2024

Preprint

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“…Giving corticosteroids can given with base mechanism anti-inflammatory action, however results from other research still controversial. Although Still controversial, some clinician still give methylprednisolone as FES prophylaxis before done operation, with dose varies from 6-90 mg/ kgbb [25]. Governance supportive become the only one possible therapy done if FES symptoms already developing, which includes supplementation oxygen For repair oxygenation, ventilation when patient experiencing respiratory distress [26].…”

Section: Resultsmentioning

confidence: 99%

Fat Emboli with Thrombocytopenia in A Patient Undergoing Operation for A 1/3 Medial Humerus Oblique Fracture

Ardianto,

Alexander,

Wahono

2024

Int Jou of PHE

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Fat embolism is a clinical syndrome characterized by the systemic spread of fat emboli which often occurs due to fractures in long bones. We report a 29 year old man with a diagnosis of a fracture of the medial third of the right humerus accompanied by thrombocytopenia which could be one of the clinical manifestations of pulmonary embolism. A 29 year old man came to the emergency room at RAA Soewondo Pati Regional Hospital with complaints of pain in his right hand 2 hours before entering the hospital. The patient felt pain after falling and slipping at home. Physical examination revealed tachycardia and tachypnea. Humeral x-ray revealed discontinuity in the medial 1/3 of the right humerus. The patient then underwent treatment for the fracture and the day after a routine blood test was carried out. Routine blood tests revealed thrombocytopenia.Fat embolism is a dangerous complication of long bone fractures. Often this fat embolism is not recognized until the patient shows symptoms in several systems, especially the respiratory system such as respiratory distress and neurological system disorders ranging from motor disorders to seizures. Apart from that, fat embolism can also disrupt the coagulation system so that thrombocytopenia can occur. In this patient there was tachypnea and thrombocytopenia which could be early symptoms of fat embolism. Fat embolism is a complication of long bone fractures that is rare but dangerous if not properly recognized. Immediate management of fractures and collaboration with anesthesiologists and internists are important to prevent fat embolism.

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“…FESの発症率や死亡率は報告により異なる。前向き研究で調査した四肢長管骨・骨盤骨折のうち11%（10/92例）の発症率とする報告 1)や，長管骨骨折患者の0.9%の発症率，7%の死亡率とする報告 2)がある。近年ではビッグデータを用いた解析による発症率の報告が散見され，AlpertらはThe Trauma Quality Improvement Program（TQIP）を解析し，四肢長管骨骨折（上腕骨，大腿骨，脛骨・腓骨，膝蓋骨）を伴う324,165症例中116例（0.04%）の発症率で，死亡率は11.2%と報告し 3)，また本邦の日本外傷データバンク（JTDB）を使用した発症率は外傷患者の0.1%に発症し，その死亡率は5.8%と報告されている 4)。FES発症率は0.04～11%，死亡率は5.8～11.2%となるが，それらはFES全体を評価したものである。…”

Section: 考　　察unclassified

神経学的後遺症を残した電撃型脂肪塞栓症候群の1例～文献レビューと予後調査～(A case of fulminant fat embolism syndrome with neurological deficit: literature review and prognosis research)

雄一

龍一郎

泰明

et al. 2023

Nihon Kyukyu Igakukai Zasshi: Japanese Journal of Japanese Asso

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要旨電撃型脂肪塞栓症候群（電撃型FES）は外傷後短時間で発症し，致死的転帰をたどり生命予後も不良と報告されているがまとまった報告はない。神経学的後遺症を残した電撃型FESの1例を生命予後・神経学的予後を調査した文献レビューとともに報告する。症例は18歳の男性。交通事故により受傷し，救出後に当院救急搬送となった。来院時ショックはなく，意識レベルはGCS E3V4M6で軽度の不穏を認めた。顔面挫滅創を認めたがCTで頭蓋内損傷はなく，右肘開放性脱臼骨折および右大腿骨骨幹部骨折を認めた。受傷後8時間で骨折に対する緊急手術を行った。術中より血圧低下あり，術後に低酸素状態・意識レベル不良であり，再挿管・人工呼吸器管理となった。直後に行ったCTで肺野のすりガラス影の出現と脳浮腫を認め，翌日には点状出血の出現を認めたため電撃型FESの診断となった。集学的治療を行ったが，けいれんの出現があり，受傷後22日に撮像した頭部MRIでは多発性の陳旧性脳梗塞像を認めた。受傷後35日の転院時E3VTM3と意思疎通は困難であった。受傷後1年の時点で追視は可能だが意思疎通困難で，随意的な四肢運動は不可能である。文献レビューでは電撃型FESは日本語文献26例，英語文献14例の症例報告があり，死亡率は43～50%で，神経学的後遺症発生率は43～56%であった。

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Fat embolism syndrome in blunt trauma patients with extremity fractures

Cited by 5 publications

References 38 publications

Epidemiology and Risk Factors for Fat Embolism in Isolated Lower Extremities Long Bone Fractures

Epidemiology and Risk Factors for Fat Embolism in Isolated Lower Extremities Long Bone Fractures

Fat Emboli with Thrombocytopenia in A Patient Undergoing Operation for A 1/3 Medial Humerus Oblique Fracture

神経学的後遺症を残した電撃型脂肪塞栓症候群の1例～文献レビューと予後調査～(A case of fulminant fat embolism syndrome with neurological deficit: literature review and prognosis research)

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