Fat embolism syndrome. A 10-year review.
Bulger EM, Smith DG, Maier RV, Jurkovich GJ
BACKGROUND: The effect of recent advances in critical care and the emphasis
on early fracture fixation in patients with fat embolism syndrome (FES)
are unknown. OBJECTIVE: To better define FES in current practice by conducting
a 10-year review of the experiences at our level I trauma center. DESIGN:
The medical records of all patients in whom FES was diagnosed from July
1, 1985, to July 1, 1995, were reviewed for demographics, injury severity
and pattern, diagnostic criteria, and management. SETTING: A level I trauma
center. RESULTS: Twenty-seven patients with clinically apparent FES were
identified. This resulted in an incidence of 0.9% of all patients with
long-bone fractures. The mean injury severity score was 9.5 (range, 4-22).
The diagnosis of FES was made by clinical criteria, including hypoxia,
26 patients (96%); mental status changes, 16 patients (59%); petechiae,
9 patients (33%); temperature higher than 39 degrees C, 19 patients (70%);
tachycardia (heart rate > 120 beats per minute), 25 patients (93%); thrombocytopenia
(platelet count < 150 x 10(9)/L), 10 patients (37%); and unexplained
anemia, 18 patients (67%). Thirteen patients (48%) had multiple long-bone
fractures, and 14 patients (52%) had a single long-bone fracture. Seven
patients (26%) had open fractures, 15 (56%) had closed fractures, and the
remaining 5 (18%) had both. Of the total fracture population, the distribution
was 81% closed, 15% open, and 4% both. Management included ventilatory
support for 12 (44%) of the patients; early operative fixation was emphasized,
and 74% of the fractures were stabilized within 24 hours of injury. This
was comparable with 76% of the total fracture population. There were 2
deaths, for a mortality of 7%. CONCLUSIONS: (1) Fat embolism syndrome remains
a diagnosis of exclusion and is based on clinical criteria. (2) Clinically
apparent FES is unusual but may be masked by associated injuries in more
severely injured patients. (3) No association could be identified between
FES and a specific fracture pattern or location. (4) Early intramedullary
fixation does not increase the incidence or severity of FES. (5) While
FES seems to have a direct effect on survival, the management of FES remains
primarily supportive.
